Provider Demographics
NPI:1194979443
Name:JONES, ANDREA N (LMT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:N
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7645 SW CAPITOL HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2436
Mailing Address - Country:US
Mailing Address - Phone:503-449-4445
Mailing Address - Fax:
Practice Address - Street 1:7645 SW CAPITOL HWY
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2436
Practice Address - Country:US
Practice Address - Phone:503-449-4445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist