Provider Demographics
NPI:1972858892
Name:JONES, JEREMY (PTA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 AUDLEY ST
Mailing Address - Street 2:6102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-2910
Mailing Address - Country:US
Mailing Address - Phone:713-858-2821
Mailing Address - Fax:
Practice Address - Street 1:3804 AUDLEY ST
Practice Address - Street 2:6102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-2910
Practice Address - Country:US
Practice Address - Phone:713-858-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2063892225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant