Provider Demographics
NPI:1104255082
Name:JONES, LYNDA LEE (PTA)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 2ND AVE.
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466
Mailing Address - Country:US
Mailing Address - Phone:715-884-2333
Mailing Address - Fax:715-884-2333
Practice Address - Street 1:5308 2ND AVE.
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466
Practice Address - Country:US
Practice Address - Phone:715-884-2333
Practice Address - Fax:715-884-2333
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI478-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant