MEDICARE: MS. KEIKO JONES PTA

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	225200000X	Physical Therapy Assistant	2021762	TX

General Provider Information

NPI Number	:	1053520536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KEIKO JONES PTA

Provider Business Mailing Address
First Line	:	5365 WONDER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1936
Country	:	US
Telephone Number	:	361-510-9806
Fax Number	:

Provider Business Practice Location Address
First Line	:	5365 WONDER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-1936
Country	:	US
Telephone Number	:	617-660-8181
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	06/26/2013

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