Provider Demographics
NPI:1518555929
Name:JONES, CHARLES LAWRENCE III (LMT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LAWRENCE
Last Name:JONES
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 BRICKNELL DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154
Mailing Address - Country:US
Mailing Address - Phone:817-437-6692
Mailing Address - Fax:
Practice Address - Street 1:1413 BRICKNELL DR
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:817-437-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty