Provider Demographics
NPI:1093171803
Name:JORDAN, JOSEPHINE L
Entity Type:Individual
Prefix:MISS
First Name:JOSEPHINE
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E EL PASO ST
Mailing Address - Street 2:APT B
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-2534
Mailing Address - Country:US
Mailing Address - Phone:432-244-9344
Mailing Address - Fax:
Practice Address - Street 1:103 E EL PASO ST
Practice Address - Street 2:APT B
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-2534
Practice Address - Country:US
Practice Address - Phone:432-244-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1237568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist