Provider Demographics
NPI:1639200017
Name:JONES, KEVIN WAYNE (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WAYNE
Last Name:JONES
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W HESS AVE
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85228-3508
Mailing Address - Country:US
Mailing Address - Phone:520-723-4641
Mailing Address - Fax:
Practice Address - Street 1:5621 S. 24TH STREET
Practice Address - Street 2:JONES CONCRETE CONSTRUCTION LLC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:602-319-1871
Practice Address - Fax:602-323-9291
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer