Provider Demographics
NPI:1639570336
Name:JONES, KEVIN (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:DPT
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 441146
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-9522
Mailing Address - Country:US
Mailing Address - Phone:678-403-3632
Mailing Address - Fax:
Practice Address - Street 1:236 PONTE VEDRA PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-6619
Practice Address - Country:US
Practice Address - Phone:904-280-3440
Practice Address - Fax:904-280-3444
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT295582081S0010X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine