Provider Demographics
NPI:1649950221
Name:JONES, LAURENS WHIPPLE III (LMT)
Entity type:Individual
Prefix:
First Name:LAURENS
Middle Name:WHIPPLE
Last Name:JONES
Suffix:III
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:400 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6315
Mailing Address - Country:US
Mailing Address - Phone:360-745-9332
Mailing Address - Fax:
Practice Address - Street 1:400 E 18TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6315
Practice Address - Country:US
Practice Address - Phone:360-745-9332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMT-2023-0266225700000X
MTLMT-LMT-LIC-25593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist