Provider Demographics
NPI:1508167149
Name:JONES, BRIAN SHAWN (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SHAWN
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 1:322 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1440
Mailing Address - Country:US
Mailing Address - Phone:570-814-7634
Mailing Address - Fax:
Practice Address - Street 1:322 JACKSON ST
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:PA
Practice Address - Zip Code:18641-1440
Practice Address - Country:US
Practice Address - Phone:570-814-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002724-E225100000X
IN05003315225100000X
CO4102225100000X
CA19090225100000X
WV2306225100000X
AR2621225100000X
MI5501007956225100000X
VA105005105225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist