Provider Demographics
NPI:1891101382
Name:JONES, TYLER (PT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:JONES
Suffix:
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 1:7125 NEW SANGER RD
Mailing Address - Street 2:STE B
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-4053
Mailing Address - Country:US
Mailing Address - Phone:254-754-0375
Mailing Address - Fax:205-621-2212
Practice Address - Street 1:7125 NEW SANGER RD
Practice Address - Street 2:STE B
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4053
Practice Address - Country:US
Practice Address - Phone:254-754-0375
Practice Address - Fax:205-621-2212
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1244298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist