Provider Demographics
NPI:1356056865
Name:JONES, WILLIAM TIMOTHY CLYDE
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TIMOTHY CLYDE
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 RANT DRUM RD
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-9068
Mailing Address - Country:US
Mailing Address - Phone:704-880-7191
Mailing Address - Fax:
Practice Address - Street 1:3152 RANT DRUM RD
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-9068
Practice Address - Country:US
Practice Address - Phone:704-880-7191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-21756225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant