Provider Demographics
NPI:1376887059
Name:JORDAN, ROBERT ARTHUR SEAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ARTHUR SEAN
Last Name:JORDAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4605
Mailing Address - Country:US
Mailing Address - Phone:513-773-5122
Mailing Address - Fax:
Practice Address - Street 1:1805 27TH ST
Practice Address - Street 2:WALLER BLDG STE. 308
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2640
Practice Address - Country:US
Practice Address - Phone:740-356-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer