Provider Demographics
NPI:1295373066
Name:COX, JORDAN (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:COX
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 1:342 COLONIAL HILL DR
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-4445
Mailing Address - Country:US
Mailing Address - Phone:276-618-0326
Mailing Address - Fax:
Practice Address - Street 1:240 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-4257
Practice Address - Country:US
Practice Address - Phone:276-629-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212808225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist