Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 002989 | WV |
NPI | 1013293950 |
---|---|
Provider Name | Dr. Rickard Dustin Jones |
First Address | Shepherdstown, WV 25443-4605 |
Second Address | Martinsburg, WV 25401-1838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2011 |
Last Update Date | 24/10/2011 |