Provider Demographics
NPI:1881667111
Name:JONES, KENNETH JR (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:JONES
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SAND HILL RD
Mailing Address - Street 2:COUNTRY MEADOWS HERSHEY
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-3411
Mailing Address - Country:US
Mailing Address - Phone:717-533-2946
Mailing Address - Fax:717-312-1671
Practice Address - Street 1:421 S BEST AVE
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-1217
Practice Address - Country:US
Practice Address - Phone:610-760-1520
Practice Address - Fax:610-760-1721
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011380L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016806440009Medicaid
PA394529Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER