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General NPI Number Information
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NPI Number | 1750739785
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Entity Type | Individual
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Provider Name | LAWRENCE JONES MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 642 E CHESTER PIKE
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City | RIDLEY PARK
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State | PA
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Zip | 19078-1701
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Country | US
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Telephone | 610-522-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 84 PETERS LN
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City | BLACKWOOD
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State | NJ
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Zip | 08012-4601
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Country | US
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Telephone | 609-828-9825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00220300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT006389
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License Number State | PA
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