Provider Demographics
NPI:1104941673
Name:JONES, STACY MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MICHELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MICHELLE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-0266
Mailing Address - Country:US
Mailing Address - Phone:479-970-1739
Mailing Address - Fax:
Practice Address - Street 1:1227 E 32ND ST STE 7
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2904
Practice Address - Country:US
Practice Address - Phone:417-624-7400
Practice Address - Fax:417-624-7403
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017042705225100000X
AR2644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist