Provider Demographics
NPI:1518437532
Name:JONES, KINYA NICOLE (LMT #MA60791076)
Entity Type:Individual
Prefix:MS
First Name:KINYA
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT #MA60791076
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 PARK POINT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7861
Mailing Address - Country:US
Mailing Address - Phone:206-305-2539
Mailing Address - Fax:
Practice Address - Street 1:8309 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4183
Practice Address - Country:US
Practice Address - Phone:206-305-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60791076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist