Provider Demographics
NPI:1538500335
Name:JONES, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13850 1ST ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-4546
Mailing Address - Country:US
Mailing Address - Phone:612-532-2792
Mailing Address - Fax:
Practice Address - Street 1:9125 QUADAY AVE NE
Practice Address - Street 2:SUITE 102
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-6651
Practice Address - Country:US
Practice Address - Phone:763-274-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist