Provider Demographics
NPI:1053977132
Name:JONAS, DWAYNE CARROLL (LPTA)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:CARROLL
Last Name:JONAS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 FRIENDLY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-6753
Mailing Address - Country:US
Mailing Address - Phone:828-234-7559
Mailing Address - Fax:
Practice Address - Street 1:220 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2532
Practice Address - Country:US
Practice Address - Phone:828-328-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant