Healthcare Provider Details

I. General information

NPI: 1962848861
Provider Name (Legal Business Name): MICHAEL PAUL JONES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W ADAMS ST
COCHRANTON PA
16314-8640
US

IV. Provider business mailing address

PO BOX 248 3236 STATE HWY 257 SUITE 1
SENECA PA
16346-0248
US

V. Phone/Fax

Practice location:
  • Phone: 814-638-0238
  • Fax: 814-638-0007
Mailing address:
  • Phone: 814-670-0534
  • Fax: 814-670-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022578
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPENDING
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: