Provider Demographics
NPI:1528195781
Name:JONES, NICHOLAS DANIEL (PT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:DANIEL
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 1:1026 H ST
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2329
Mailing Address - Country:US
Mailing Address - Phone:719-239-1059
Mailing Address - Fax:
Practice Address - Street 1:28350 COUNTY ROAD 317
Practice Address - Street 2:SUITE 1
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-395-3124
Practice Address - Fax:719-395-3128
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO806804Medicare ID - Type Unspecified