Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor | 0715002119 | VA |
Y | 226300000X | Kinesiotherapist | 1114 | VA |
NPI | 1003872565 |
---|---|
Provider Name | Mr. Anthony Lynn Jones |
First Address | Hampton, VA 23666-1697 |
Second Address | Hampton, VA 23667-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 12/05/2021 |