Provider Demographics
NPI:1639279623
Name:JONES, PAUL ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANDREW
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 1:389 HIGHWAY 21
Mailing Address - Street 2:STE.403
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3407
Mailing Address - Country:US
Mailing Address - Phone:985-792-5996
Mailing Address - Fax:
Practice Address - Street 1:389 HIGHWAY 21
Practice Address - Street 2:STE.403
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3407
Practice Address - Country:US
Practice Address - Phone:985-792-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01165F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH3749OtherBCBS MEMBER #
LA4H696Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER