Provider Demographics
NPI:1679777593
Name:JONES, SHERRY DAWN (PTA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DAWN
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ZACHERY ST
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62814
Mailing Address - Country:US
Mailing Address - Phone:618-204-5497
Mailing Address - Fax:618-204-5487
Practice Address - Street 1:208 ZACHERY STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:IL
Practice Address - Zip Code:62814
Practice Address - Country:US
Practice Address - Phone:618-204-5497
Practice Address - Fax:618-204-5487
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist