Provider Demographics
NPI:1730120247
Name:JONES PT PHYSICAL THERAPY AND PHYSICAL TRAINING
Entity Type:Organization
Organization Name:JONES PT PHYSICAL THERAPY AND PHYSICAL TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MANDISA
Authorized Official - Middle Name:SHANI
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:404-377-9107
Mailing Address - Street 1:235 E PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3452
Mailing Address - Country:US
Mailing Address - Phone:404-377-9107
Mailing Address - Fax:404-377-9109
Practice Address - Street 1:235 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3488
Practice Address - Country:US
Practice Address - Phone:404-377-9107
Practice Address - Fax:404-377-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty