Provider Demographics
NPI:1801296538
Name:JONES, MCKAY (ATC)
Entity type:Individual
Prefix:
First Name:MCKAY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 S 200 E
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725
Mailing Address - Country:US
Mailing Address - Phone:435-231-3152
Mailing Address - Fax:
Practice Address - Street 1:565 S 200 E
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-231-3152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8410114-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer