Provider Demographics
NPI:1619733144
Name:JONES, KENDALL NOEL (PTA)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:NOEL
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1350
Mailing Address - Country:US
Mailing Address - Phone:949-616-9922
Mailing Address - Fax:
Practice Address - Street 1:32261 CAMINO CAPISTRANO STE D101
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3747
Practice Address - Country:US
Practice Address - Phone:949-429-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49239225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant