Provider Demographics
NPI:1699974618
Name:JONES, GINA (LMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13341 OLDE WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-4896
Mailing Address - Country:US
Mailing Address - Phone:773-238-3349
Mailing Address - Fax:
Practice Address - Street 1:13341 OLDE WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-4896
Practice Address - Country:US
Practice Address - Phone:332-778-2438
Practice Address - Fax:708-350-0511
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227006376225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist