Provider Demographics
NPI:1255668042
Name:JONES, ELISSA (PT)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
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 1:323 INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-8069
Mailing Address - Country:US
Mailing Address - Phone:601-657-1000
Mailing Address - Fax:601-657-9121
Practice Address - Street 1:323 INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-8069
Practice Address - Country:US
Practice Address - Phone:601-657-1000
Practice Address - Fax:601-657-9121
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230121Medicaid
MS1912997685Medicare UPIN
MS00230121Medicaid