Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043558505 |
---|---|
Provider Name | Sage Cody Jones |
First Address | Pahrump, NV 89048-5603 |
Second Address | Pahrump, NV 89048-5603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2013 |
Last Update Date | 17/01/2013 |