Provider Demographics
NPI:1104232099
Name:JONES, MARISSA (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WHEELOCK ST
Mailing Address - Street 2:APT E5
Mailing Address - City:FRANKLIN
Mailing Address - State:TX
Mailing Address - Zip Code:77856-4040
Mailing Address - Country:US
Mailing Address - Phone:601-259-1504
Mailing Address - Fax:
Practice Address - Street 1:801 WHEELOCK ST APT E5
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TX
Practice Address - Zip Code:77856-4035
Practice Address - Country:US
Practice Address - Phone:601-259-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT53912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer