Provider Demographics
NPI:1689021065
Name:JONES, DORISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:DORISTINE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8538 HUNTERS CREEK DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9062
Mailing Address - Country:US
Mailing Address - Phone:904-631-5886
Mailing Address - Fax:
Practice Address - Street 1:8640 PHILIPS HWY
Practice Address - Street 2:SU. #10
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1207
Practice Address - Country:US
Practice Address - Phone:904-469-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA75247225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist