Provider Demographics
NPI:1437187663
Name:JONES, ALVIN L (RPT)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9362 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2505
Mailing Address - Country:US
Mailing Address - Phone:208-672-8144
Mailing Address - Fax:208-672-8145
Practice Address - Street 1:9362 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2505
Practice Address - Country:US
Practice Address - Phone:208-672-8144
Practice Address - Fax:208-672-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1652528Medicare ID - Type Unspecified