Provider Demographics
NPI:1184218166
Name:RODRIGUES, JORDAN PAUL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAUL
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:4833 BEREWICK TOWN CENTER DR STE H
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-6721
Practice Address - Country:US
Practice Address - Phone:980-880-6780
Practice Address - Fax:980-474-4937
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11202225100000X
NCP20089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist