Provider Demographics
NPI:1942640404
Name:JONES, MAGDALENE HENSS (DPT)
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:HENSS
Last Name:JONES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13857 N HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:SUMMERS
Mailing Address - State:AR
Mailing Address - Zip Code:72769-9619
Mailing Address - Country:US
Mailing Address - Phone:217-621-3203
Mailing Address - Fax:
Practice Address - Street 1:609 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-757-4700
Practice Address - Fax:479-757-2949
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010614A225100000X
ARPT3990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN129137500OtherUS DEPT OF LABOR
IN156540Medicaid
IN100124000Medicaid