Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1140507 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1140507 | TX |
NPI | 1336241793 |
---|---|
Provider Name | Mr. William Jeffrey Jones |
First Address | Dallas, TX 75238-2732 |
Second Address | Dallas, TX 75238-2732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 20/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86450T | BLUE CROSS/BLUE SHIELD (01) | TX |