Provider Demographics
NPI:1215414479
Name:GAUTHIER, JORDAN K (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:K
Last Name:GAUTHIER
Suffix:
Gender:F
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 1:7801 N LAMAR BLVD STE B174
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1032
Mailing Address - Country:US
Mailing Address - Phone:512-371-7273
Mailing Address - Fax:
Practice Address - Street 1:7801 N LAMAR BLVD STE B174
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1032
Practice Address - Country:US
Practice Address - Phone:512-371-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1303810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist