Provider Demographics
NPI:1053655829
Name:CORDES, JAYDE (DPT)
Entity Type:Individual
Prefix:
First Name:JAYDE
Middle Name:
Last Name:CORDES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951-2137
Mailing Address - Country:US
Mailing Address - Phone:620-544-7823
Mailing Address - Fax:620-544-7826
Practice Address - Street 1:525 S POLK ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2137
Practice Address - Country:US
Practice Address - Phone:620-544-7823
Practice Address - Fax:620-544-7826
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-03475225100000X
KS11-04991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist