Provider Demographics
NPI:1316433675
Name:JONES, REBAKAH AMANDA (LMT, ICT, CST, MMP)
Entity type:Individual
Prefix:MISS
First Name:REBAKAH
Middle Name:AMANDA
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT, ICT, CST, MMP
Other - Prefix:MISS
Other - First Name:REBAKAH
Other - Middle Name:AMANDA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, ICT, CST, MMP
Mailing Address - Street 1:23123 CAMDEN WAY STE 1C
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-2447
Mailing Address - Country:US
Mailing Address - Phone:301-750-3307
Mailing Address - Fax:
Practice Address - Street 1:23123 CAMDEN WAY STE 1C
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2447
Practice Address - Country:US
Practice Address - Phone:301-750-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty