Provider Demographics
NPI:1265818413
Name:SIEGMANN, JORDAN E (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:E
Last Name:SIEGMANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:E
Other - Last Name:STORRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:978-840-1900
Mailing Address - Fax:978-840-1263
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3289
Practice Address - Country:US
Practice Address - Phone:978-840-1900
Practice Address - Fax:978-840-1263
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist