Provider Demographics
NPI:1326581497
Name:JONAS, JORDAN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:JONAS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:CRILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1204
Mailing Address - Country:US
Mailing Address - Phone:717-945-9284
Mailing Address - Fax:
Practice Address - Street 1:200 IRISH RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1260
Practice Address - Country:US
Practice Address - Phone:717-945-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PARTO000325247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program