Provider Demographics
NPI:1619011103
Name:JONES, DAVIS TODD (PT)
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:TODD
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 1:1453 N 400 E
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1232
Mailing Address - Country:US
Mailing Address - Phone:801-292-4521
Mailing Address - Fax:
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:BURN THERAPY DEPT.
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84132-1232
Practice Address - Country:US
Practice Address - Phone:801-581-2132
Practice Address - Fax:801-585-3087
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT121356-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist