Provider Demographics
NPI:1447464300
Name:JONES, CARLA MICHELLE (PTA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MICHELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ENOREE
Mailing Address - State:SC
Mailing Address - Zip Code:29335-6327
Mailing Address - Country:US
Mailing Address - Phone:864-969-4602
Mailing Address - Fax:
Practice Address - Street 1:301 PINEHAVEN STREET EXT
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2671
Practice Address - Country:US
Practice Address - Phone:864-984-6584
Practice Address - Fax:864-984-6464
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC462225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant