Provider Demographics
NPI:1568785707
Name:JONES, DESIREE NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 HIGHWAY 69 S
Mailing Address - Street 2:SUITE N
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3964
Mailing Address - Country:US
Mailing Address - Phone:205-345-5035
Mailing Address - Fax:205-345-5034
Practice Address - Street 1:6521 HIGHWAY 69 S
Practice Address - Street 2:SUITE N
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-3964
Practice Address - Country:US
Practice Address - Phone:205-345-5035
Practice Address - Fax:205-345-5034
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist