Provider Demographics
NPI:1114190758
Name:KONDRAT, JORDAN ANNE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:ANNE
Last Name:KONDRAT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:JORDAN
Other - Middle Name:ANNE
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2006 STONINGTON CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-3262
Mailing Address - Country:US
Mailing Address - Phone:248-650-4488
Mailing Address - Fax:248-650-4488
Practice Address - Street 1:6405 TELEGRAPH RD
Practice Address - Street 2:STE E3
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-1716
Practice Address - Country:US
Practice Address - Phone:248-650-4488
Practice Address - Fax:248-650-4488
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist