MEDICARE: MR. THOMAS MICHAEL 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	3452-024	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3452-024	OTHER	WI	STATE LICENSE PT

General Provider Information

NPI Number	:	1376696989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MICHAEL JONES PT

Provider Business Mailing Address
First Line	:	7 MARGARET AVE
Second Line	:
City	:	FORT ATKINSON
State	:	WI
Zip	:	53538-9391
Country	:	US
Telephone Number	:	920-563-1084
Fax Number	:

Provider Business Practice Location Address
First Line	:	1461 W MAIN ST
Second Line	:
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1568
Country	:	US
Telephone Number	:	262-473-5599
Fax Number	:	262-473-8522

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/09/2007

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