Provider Demographics
NPI:1124262779
Name:JONES, KELLY LIANA
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LIANA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5526
Mailing Address - Country:US
Mailing Address - Phone:952-393-6086
Mailing Address - Fax:
Practice Address - Street 1:328 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5251
Practice Address - Country:US
Practice Address - Phone:507-332-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist