MEDICARE: EMILY JONES

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	2132150	TX

General Provider Information

NPI Number	:	1457025595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY JONES

Provider Business Mailing Address
First Line	:	1001 12TH AVE # 20
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3926
Country	:	US
Telephone Number	:	817-714-7719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 12TH AVE # 20
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-3926
Country	:	US
Telephone Number	:	817-719-7714
Fax Number	:

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

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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Directions to “ EMILY JONES ” Practice Location

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