Provider Demographics
NPI:1346640711
Name:MARTINE, JORDAN RACKLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RACKLEY
Last Name:MARTINE
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 1:5710 OLEANDER DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4766
Mailing Address - Country:US
Mailing Address - Phone:910-398-6301
Mailing Address - Fax:
Practice Address - Street 1:1630 MILITARY CUTOFF RD STE 110
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5719
Practice Address - Country:US
Practice Address - Phone:910-798-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist