Provider Demographics
NPI:1164165700
Name:PIROS, JORDAN SMITH (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SMITH
Last Name:PIROS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 REESE WAY
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-6037
Mailing Address - Country:US
Mailing Address - Phone:912-658-9584
Mailing Address - Fax:
Practice Address - Street 1:117 REESE WAY
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-6037
Practice Address - Country:US
Practice Address - Phone:912-658-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004532208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation