Provider Demographics
NPI:1821402884
Name:JONES, JACKLEEN W (DPT)
Entity type:Individual
Prefix:
First Name:JACKLEEN
Middle Name:W
Last Name:JONES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 PREMIER DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2355
Mailing Address - Country:US
Mailing Address - Phone:972-265-9402
Mailing Address - Fax:972-767-4003
Practice Address - Street 1:3209 PREMIER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2355
Practice Address - Country:US
Practice Address - Phone:972-265-9402
Practice Address - Fax:972-767-4003
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1243887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist