Provider Demographics
NPI:1447382239
Name:JONES, KENNETH (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 W CLEARWATER AVE
Mailing Address - Street 2:SUITE B101
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1694
Mailing Address - Country:US
Mailing Address - Phone:509-544-0265
Mailing Address - Fax:509-987-1614
Practice Address - Street 1:116 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1304
Practice Address - Country:US
Practice Address - Phone:509-488-0773
Practice Address - Fax:509-488-0964
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0181057OtherLABOR AND INDUSTRIES
WA8383523Medicaid
WA0181057OtherLABOR AND INDUSTRIES