Provider Demographics
NPI:1093312589
Name:DUVALL, JORDEN E (LMT)
Entity Type:Individual
Prefix:
First Name:JORDEN
Middle Name:E
Last Name:DUVALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 W ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2403
Mailing Address - Country:US
Mailing Address - Phone:502-667-0519
Mailing Address - Fax:
Practice Address - Street 1:703 W ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2403
Practice Address - Country:US
Practice Address - Phone:502-667-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist