C Jones

Individual provider Active NPI Geriatric Physical Therapist · Sweeny, TX

NPI 1245476902 · NPPES record last updated Jan 10, 2012

Key facts

NPI
1245476902
Entity type
Individual (NPI type 1)
Primary specialty
Geriatric Physical Therapist 2251G0304X
Practice address
109 N McKinney St
Sweeny, TX 77480-3400
Phone
(443) 310-9611
NPI assigned
Dec 31, 2008
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
20694MDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Excellence Care Rehab&Nursing Services Inc Geriatrics Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X Yes

Addresses

Primary practice location

109 N McKinney St
Sweeny, TX 77480-3400

Mailing address

9164 Canterbury Riding
Laurel, MD 20723-1454

Other identifiers

IdentifierTypeStateIssuer
1952422412MedicaidTX

Other providers in Sweeny, TX

All providers in Sweeny, TX · Geriatric Physical Therapist in Texas

Sources for this page

Verify at the official NPI Registry.