MEDICARE: GARRIS NICOLE 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

General Provider Information

NPI Number	:	1679019988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRIS NICOLE JONES PT

Provider Business Mailing Address
First Line	:	6404 SHORE DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2579
Country	:	US
Telephone Number	:	334-648-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	6404 SHORE DR
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-2579
Country	:	US
Telephone Number	:	334-648-2019
Fax Number	:

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

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	04/13/2022

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