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NPI Code Detail

MEDICARE: MATTHEW MICHAEL DOUGLAS JONES

MEDICARE: MATTHEW MICHAEL DOUGLAS 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
1225200000XPhysical Therapy Assistant5502004072MI

General Provider Information

NPI Number : 1780235580
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW MICHAEL DOUGLAS JONES
Provider Business Mailing Address
First Line : 2627 BOTHAM CT
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-1917
Country : US
Telephone Number : 269-449-8296
Fax Number :
Provider Business Practice Location Address
First Line : 3905 LORRAINE PATH
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-8630
Country : US
Telephone Number : 269-428-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2019
Last Update Date : 09/23/2019

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