1427018241 NPI number — NICOLE ALEXANDRA JONES M.P.T., M.T.C.

Table of content: NICOLE ALEXANDRA JONES M.P.T., M.T.C. (NPI 1427018241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427018241 NPI number — NICOLE ALEXANDRA JONES M.P.T., M.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
NICOLE
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.P.T., M.T.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BIBERGER
Provider Other First Name:
NICOLE
Provider Other Middle Name:
ALEXANDRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427018241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2569 152ND AVE NE
Provider Second Line Business Mailing Address:
BLDG 15, UNIT C
Provider Business Mailing Address City Name:
REDMOND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-497-8180
Provider Business Mailing Address Fax Number:
425-881-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2569 152ND AVE NE
Provider Second Line Business Practice Location Address:
BLDG 15, UNIT C
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-497-8180
Provider Business Practice Location Address Fax Number:
425-881-3585
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00009347 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8396186 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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