Healthcare Provider Details

I. General information

NPI: 1104006667
Provider Name (Legal Business Name): DANNI JONES PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 NORTH MONROE STREET
RUSTON LA
71270
US

IV. Provider business mailing address

108 NORTH MONROE STREET
RUSTON LA
71270
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-2995
  • Fax: 318-251-2996
Mailing address:
  • Phone: 318-251-2995
  • Fax: 318-251-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number07083
License Number StateLA

VIII. Authorized Official

Name: DANIELLE D JONES
Title or Position: PT/OWNER
Credential: RPT
Phone: 318-251-2995