Provider Demographics
NPI:1174280598
Name:BUSHMAN, JOURDAN PAIGE
Entity Type:Individual
Prefix:
First Name:JOURDAN
Middle Name:PAIGE
Last Name:BUSHMAN
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 1:825 DAVIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7009
Mailing Address - Country:US
Mailing Address - Phone:540-381-9100
Mailing Address - Fax:540-381-9102
Practice Address - Street 1:65 SHENANDOAH AVE STE 203
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3205
Practice Address - Country:US
Practice Address - Phone:540-381-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist