Provider Demographics
NPI:1255588000
Name:JONES, JEAN MARIE (LMT)
Entity type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 SE 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-5620
Mailing Address - Country:US
Mailing Address - Phone:503-777-8342
Mailing Address - Fax:
Practice Address - Street 1:7005 SW NYBERG ST
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-6243
Practice Address - Country:US
Practice Address - Phone:503-783-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14611172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist