Provider Demographics
NPI:1013064484
Name:JONES, JAMES R (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
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 1:4021 IBIS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3005
Mailing Address - Country:US
Mailing Address - Phone:407-579-6821
Mailing Address - Fax:
Practice Address - Street 1:811 S ORLANDO AVE STE H
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7102
Practice Address - Country:US
Practice Address - Phone:407-628-5500
Practice Address - Fax:407-628-5505
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA#13902225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant