Basic Information
| Provider Information | |||||||||
| NPI: | 1982804464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | BERTHA | ||||||||
| MiddleName: | HEINL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HEINL | ||||||||
| OtherFirstName: | BERTHA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1945 SCOTTSVILLE RD | ||||||||
| Address2: | B2, PMB 356 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421043376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708428824 | ||||||||
| FaxNumber: | 2708427917 | ||||||||
| Practice Location | |||||||||
| Address1: | 1908 CHEROKEE AVE SW | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350555502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562550426 | ||||||||
| FaxNumber: | 2562550427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH2829 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.