Provider Demographics
NPI:1215455589
Name:JONES, KRISTEN L (PTA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:L
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 1:550 E THIRD ST
Mailing Address - Street 2:
Mailing Address - City:HERSCHER
Mailing Address - State:IL
Mailing Address - Zip Code:60941-9463
Mailing Address - Country:US
Mailing Address - Phone:815-474-5005
Mailing Address - Fax:
Practice Address - Street 1:550 E THIRD ST
Practice Address - Street 2:
Practice Address - City:HERSCHER
Practice Address - State:IL
Practice Address - Zip Code:60941-9463
Practice Address - Country:US
Practice Address - Phone:815-474-5005
Practice Address - Fax:815-474-5005
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.007227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant