MEDICARE: STEFAN DANIEL JONES DPT

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	18569	NC

General Provider Information

NPI Number	:	1588283535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN DANIEL JONES DPT

Provider Business Mailing Address
First Line	:	555 SHADY LN
Second Line	:
City	:	WILKESBORO
State	:	NC
Zip	:	28697-3013
Country	:	US
Telephone Number	:	336-964-0209
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 WINSTON RD STE B
Second Line	:
City	:	JONESVILLE
State	:	NC
Zip	:	28642-2217
Country	:	US
Telephone Number	:	336-964-0309
Fax Number	:

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

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/09/2020

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