Provider Demographics
NPI:1013953462
Name:JONES, JEREMY L (DPT)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:L
Last Name:JONES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 CHANNING WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7517
Mailing Address - Country:US
Mailing Address - Phone:208-552-2248
Mailing Address - Fax:208-552-2463
Practice Address - Street 1:2640 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7517
Practice Address - Country:US
Practice Address - Phone:208-552-2248
Practice Address - Fax:208-552-2463
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1732225100000X, 225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806626400Medicaid
ID907630295Medicaid
ID806626400Medicaid
ID1654684Medicare PIN