Provider Demographics
NPI:1760114177
Name:JONES, TYESHA (LMT, RMT, CHT)
Entity Type:Individual
Prefix:MS
First Name:TYESHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT, RMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 DURWOOD EVANS RD
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-6545
Mailing Address - Country:US
Mailing Address - Phone:910-337-6708
Mailing Address - Fax:
Practice Address - Street 1:206 N 4TH ST STE 4
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4028
Practice Address - Country:US
Practice Address - Phone:910-337-6708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist