Provider Demographics
NPI:1063606192
Name:JONES, LISA E (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:E
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5435 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351
Mailing Address - Country:US
Mailing Address - Phone:318-253-8846
Mailing Address - Fax:318-253-8875
Practice Address - Street 1:5435 HWY 1
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351
Practice Address - Country:US
Practice Address - Phone:318-253-8846
Practice Address - Fax:318-253-8875
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist