Provider Demographics
NPI:1396192795
Name:AZINGER, JORDAN D (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:D
Last Name:AZINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9903 CLUB SPRINGS WAY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4216
Mailing Address - Country:US
Mailing Address - Phone:502-572-4735
Mailing Address - Fax:
Practice Address - Street 1:2116 BUECHEL BANK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3521
Practice Address - Country:US
Practice Address - Phone:502-488-9383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYT1606225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant