Provider Demographics
NPI:1225647027
Name:PRUTZER, JORDAN ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:PRUTZER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 SANDY DR STE A
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2205
Mailing Address - Country:US
Mailing Address - Phone:814-261-8122
Mailing Address - Fax:814-861-4292
Practice Address - Street 1:2160 SANDY DR STE A
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2205
Practice Address - Country:US
Practice Address - Phone:814-861-8122
Practice Address - Fax:814-861-4292
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT031772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty