Provider Demographics
NPI:1518142587
Name:JONES, CAMERON SR (PT)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:
Last Name:JONES
Suffix:SR
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 1:34 SHINING WILLOW WAY UNIT 307
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4224
Mailing Address - Country:US
Mailing Address - Phone:301-943-3613
Mailing Address - Fax:
Practice Address - Street 1:3317 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4862
Practice Address - Country:US
Practice Address - Phone:301-818-5527
Practice Address - Fax:240-913-9223
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD606MMedicare PIN