Provider Demographics
NPI:1538345541
Name:JONES, DONNA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
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 1:375 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-1053
Mailing Address - Country:US
Mailing Address - Phone:765-832-1631
Mailing Address - Fax:
Practice Address - Street 1:375 S 11TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-1053
Practice Address - Country:US
Practice Address - Phone:765-832-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002188A225200000X
TX2058143225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN06002188AOtherINDIANA STATE ISSUED