Provider Demographics
NPI:1114054293
Name:JORDAN, THOMAS BRET (MS RPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRET
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MS RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E LOULA ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5402
Mailing Address - Country:US
Mailing Address - Phone:913-634-6844
Mailing Address - Fax:
Practice Address - Street 1:534 E LOULA ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5402
Practice Address - Country:US
Practice Address - Phone:913-634-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-1516225100000X
MO01543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist