Provider Demographics
NPI:1184303190
Name:JONES, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 HIGHWAY 71 S STE 10
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9151
Mailing Address - Country:US
Mailing Address - Phone:479-763-7008
Mailing Address - Fax:479-763-1425
Practice Address - Street 1:9220 HIGHWAY 71 S STE 10
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9151
Practice Address - Country:US
Practice Address - Phone:479-763-7008
Practice Address - Fax:479-763-1425
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4847225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant