Provider Demographics
NPI:1639270606
Name:JONES, LISA MAE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MAE
Last Name:JONES
Suffix:
Gender:F
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:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04640-0169
Mailing Address - Country:US
Mailing Address - Phone:207-422-3779
Mailing Address - Fax:
Practice Address - Street 1:44 B&B DRIVE
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:ME
Practice Address - Zip Code:04640-0169
Practice Address - Country:US
Practice Address - Phone:207-422-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT17022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038901Medicare UPIN