Provider Demographics
NPI:1649207804
Name:JONES, SHELLENE ANN (MPT)
Entity Type:Individual
Prefix:
First Name:SHELLENE
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 SAN FELIPE RD
Mailing Address - Street 2:100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1503
Mailing Address - Country:US
Mailing Address - Phone:408-238-1552
Mailing Address - Fax:408-238-1552
Practice Address - Street 1:4205 SAN FELIPE RD
Practice Address - Street 2:100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1503
Practice Address - Country:US
Practice Address - Phone:408-238-1552
Practice Address - Fax:408-238-1552
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT241293Medicare PIN
CA0PT241292Medicare PIN