MEDICARE: CLENNYSHA JONES PT, DPT

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	PT014915	GA

General Provider Information

NPI Number	:	1669071155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLENNYSHA JONES PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	3885 PRINCETON LAKES WAY SW STE 408
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5599
Country	:	US
Telephone Number	:	404-344-2823
Fax Number	:	404-629-3737

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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