Provider Demographics
NPI:1720063282
Name:JONES, BRIAN DAVID (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:JONES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 S WATSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3433
Mailing Address - Country:US
Mailing Address - Phone:623-289-1916
Mailing Address - Fax:623-289-1916
Practice Address - Street 1:980 S WATSON RD STE 101
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3433
Practice Address - Country:US
Practice Address - Phone:623-289-1916
Practice Address - Fax:623-289-1916
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10157225100000X
PAPT-012616L225100000X
AZLPT-008464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830004OtherMEDICARE NSC PV
AZ5550830006OtherMEDICARE NSC ANTHEM
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ5550830008OtherMEDICARE NSC SWV
AZ433109Medicaid
AZ5550830007OtherMEDICARE NSC DV
AZ5550830010OtherMEDICARE NSC GILBERT
AZ5550830007OtherMEDICARE NSC DV