Basic Information
| Provider Information | |||||||||
| NPI: | 1710526785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 MEDSTAR BLVD STE 255 | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210151798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108778078 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 MEDSTAR BLVD STE 255 | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210151798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108778078 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2019 | ||||||||
| LastUpdateDate: | 12/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251N0400X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No ID Information.