Provider Demographics
NPI:1588730139
Name:JONES, JANICE ELLEN (PT)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:ELLEN
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 BENNINGTON HOLLOW LANE
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194
Mailing Address - Country:US
Mailing Address - Phone:703-707-3775
Mailing Address - Fax:703-435-3560
Practice Address - Street 1:435 CARLISLE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170
Practice Address - Country:US
Practice Address - Phone:703-707-3775
Practice Address - Fax:703-435-8560
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA591165Medicare ID - Type Unspecified