Provider Demographics
NPI:1699594085
Name:JONES, SANDRA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1037
Mailing Address - Country:US
Mailing Address - Phone:269-414-8902
Mailing Address - Fax:
Practice Address - Street 1:62086 ROBBINS LAKE RD
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:MI
Practice Address - Zip Code:49061-9738
Practice Address - Country:US
Practice Address - Phone:269-506-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist