Provider Demographics
NPI:1477943470
Name:JONES, MINDY LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:LYNN
Other - Last Name:WEILAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:3247 FRESNO RD NW
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9211
Mailing Address - Country:US
Mailing Address - Phone:419-217-1012
Mailing Address - Fax:
Practice Address - Street 1:3844 11TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1492
Practice Address - Country:US
Practice Address - Phone:419-217-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.02928261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy