Provider Demographics
NPI:1902420805
Name:JONES, JESSICA MERIE (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MERIE
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 FLATIRON LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5460
Mailing Address - Country:US
Mailing Address - Phone:818-209-9208
Mailing Address - Fax:
Practice Address - Street 1:140 DIAMOND CREEK PL STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-7188
Practice Address - Country:US
Practice Address - Phone:916-206-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA8249225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant