Provider Demographics
NPI:1518785435
Name:JONES, JACKY DEAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JACKY
Middle Name:DEAN
Last Name:JONES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JD
Other - Middle Name:DEAN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5611 40TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2216
Mailing Address - Country:US
Mailing Address - Phone:360-328-6689
Mailing Address - Fax:
Practice Address - Street 1:926 N 165TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5304
Practice Address - Country:US
Practice Address - Phone:360-328-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61559081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist