Provider Demographics
NPI:1487739405
Name:JONES, CAMILLE M (PT)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:M
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 1:1130 BELT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3668
Mailing Address - Country:US
Mailing Address - Phone:972-675-8641
Mailing Address - Fax:972-675-8657
Practice Address - Street 1:525 E CENTERVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-4648
Practice Address - Country:US
Practice Address - Phone:972-864-8641
Practice Address - Fax:972-864-8645
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9593Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER