MEDICARE: MS. CHRISTINE A 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	PT11079	CA

General Provider Information

NPI Number	:	1003117110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE A JONES PT

Provider Business Mailing Address
First Line	:	2706 VISTA ARROYO DR.
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9339
Country	:	US
Telephone Number	:	805-504-3863
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 VISTA ARROYO DR
Second Line	:
City	:	SANTA ROSA VALLEY
State	:	CA
Zip	:	93012-9339
Country	:	US
Telephone Number	:	805-504-3863
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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