Provider Demographics
NPI:1396067823
Name:SUSAN D. JONES, R.P.T., LLC
Entity type:Organization
Organization Name:SUSAN D. JONES, R.P.T., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:541-389-9066
Mailing Address - Street 1:19625 BLUE SKY LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3144
Mailing Address - Country:US
Mailing Address - Phone:541-389-9066
Mailing Address - Fax:
Practice Address - Street 1:595 SW BLUFF DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1282
Practice Address - Country:US
Practice Address - Phone:541-383-2185
Practice Address - Fax:541-388-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227947Medicaid