Provider Demographics
NPI:1982804464
Name:JONES, BERTHA HEINL (PT)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:HEINL
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:ANN
Other - Last Name:HEINL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1945 SCOTTSVILLE RD
Mailing Address - Street 2:B2, PMB 356
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3376
Mailing Address - Country:US
Mailing Address - Phone:270-842-8824
Mailing Address - Fax:270-842-7917
Practice Address - Street 1:1908 CHEROKEE AVE SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5502
Practice Address - Country:US
Practice Address - Phone:256-255-0426
Practice Address - Fax:256-255-0427
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist