Provider Demographics
NPI:1982873493
Name:JONES, RUDOLPH MICKEY (PT, DPT, CBC, RN)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:MICKEY
Last Name:JONES
Suffix:
Gender:M
Credentials:PT, DPT, CBC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1199
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-1199
Mailing Address - Country:US
Mailing Address - Phone:239-694-9102
Mailing Address - Fax:239-694-9101
Practice Address - Street 1:2724 5TH ST W STE BC
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1581
Practice Address - Country:US
Practice Address - Phone:239-694-9102
Practice Address - Fax:239-694-9101
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY920379163W00000X
FLPT00009763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty