Provider Demographics
NPI:1912319955
Name:JONES, ANDREW MICHAEL (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHAEL
Last Name:JONES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SHARON ST
Mailing Address - Street 2:PO BOX 60
Mailing Address - City:ARENA
Mailing Address - State:WI
Mailing Address - Zip Code:53503-9612
Mailing Address - Country:US
Mailing Address - Phone:507-216-1396
Mailing Address - Fax:
Practice Address - Street 1:1051 CLARK ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-2321
Practice Address - Country:US
Practice Address - Phone:608-524-7500
Practice Address - Fax:608-524-7599
Is Sole Proprietor?:No
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2160-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant