Basic Information
| Provider Information | |||||||||
| NPI: | 1811270556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | AARON | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12702 TOEPPERWEIN RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782333278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106534420 | ||||||||
| FaxNumber: | 2106533183 | ||||||||
| Practice Location | |||||||||
| Address1: | 12702 TOEPPERWEIN RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782333278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106534420 | ||||||||
| FaxNumber: | 2106533183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2011 | ||||||||
| LastUpdateDate: | 09/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1211055 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.