Provider Demographics
NPI:1184697823
Name:JONES, MICHAEL FABIAN (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FABIAN
Last Name:JONES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 MURDOCH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3248
Mailing Address - Country:US
Mailing Address - Phone:304-428-3086
Mailing Address - Fax:304-428-5439
Practice Address - Street 1:4420 ROSEMAR ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1255
Practice Address - Country:US
Practice Address - Phone:304-428-3086
Practice Address - Fax:304-428-5439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV000174225100000X
OH003380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0158249000Medicaid
OH0952269Medicaid
WV000697465OtherBCBS
OH0952269Medicaid