Provider Demographics
NPI:1760533954
Name:JONES, RYAN P (P T)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:P
Last Name:JONES
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 N MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1426
Mailing Address - Country:US
Mailing Address - Phone:309-266-5488
Mailing Address - Fax:309-266-9144
Practice Address - Street 1:1909 N MORTON AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1426
Practice Address - Country:US
Practice Address - Phone:309-266-5488
Practice Address - Fax:309-266-9144
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33466443OtherTRICARE PROVIDER NUM
IL0039040224OtherIL BLUE CROSS BLUE SHIELD
11581829OtherCAQH PROVIDER ID
ILP00205269OtherRAILROAD MEDICARE PIN NUM
ILP00205269OtherRAILROAD MEDICARE PIN NUM