Provider Demographics
NPI:1336354232
Name:JONES, MARYLEEN K (PT)
Entity type:Individual
Prefix:MRS
First Name:MARYLEEN
Middle Name:K
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARYLEEN
Other - Middle Name:K
Other - Last Name:MENTGEN
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 175TH ST
Mailing Address - Street 2:#101
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-4610
Mailing Address - Country:US
Mailing Address - Phone:708-957-8326
Mailing Address - Fax:
Practice Address - Street 1:1055 175TH ST
Practice Address - Street 2:#101
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-4610
Practice Address - Country:US
Practice Address - Phone:708-957-8326
Practice Address - Fax:708-957-8353
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-004037225200000X
IL070-016312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant