MEDICARE: MR. MARK ALLEN JONES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1129831	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T2906	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1235173733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ALLEN JONES PT

Provider Business Mailing Address
First Line	:	PO BOX 1615
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-1475
Country	:	US
Telephone Number	:	979-542-7300
Fax Number	:	979-542-7373

Provider Business Practice Location Address
First Line	:	2428 E AUSTIN ST
Second Line	:
City	:	GIDDINGS
State	:	TX
Zip	:	78942-3648
Country	:	US
Telephone Number	:	979-542-7300
Fax Number	:	979-542-7373

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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