Provider Demographics
NPI:1861479388
Name:JONES, MICHAEL LANE (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LANE
Last Name:JONES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 HWY 78 EAST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-9532
Mailing Address - Country:US
Mailing Address - Phone:205-384-1941
Mailing Address - Fax:
Practice Address - Street 1:2980 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-384-1941
Practice Address - Fax:205-384-6362
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR62444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051071218OtherBC/BS OF ALABAMA
AL650005667OtherRAILROAD MEDICARE
AL000071218Medicaid
AL000071218Medicaid
AL0879600001Medicare NSC
ALR62444Medicare UPIN
AL650005667OtherRAILROAD MEDICARE