Provider Demographics
NPI:1407447113
Name:GACCIONE, JORDEN LEIGH (ATC)
Entity Type:Individual
Prefix:
First Name:JORDEN
Middle Name:LEIGH
Last Name:GACCIONE
Suffix:
Gender:F
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:MIDDLE TENNESSEE STATE UNIVERSITY 1672 GREENLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37132-0001
Mailing Address - Country:US
Mailing Address - Phone:615-898-2300
Mailing Address - Fax:
Practice Address - Street 1:MIDDLE TENNESSEE STATE UNIVERSITY 1672 GREENLAND DRIVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37132-0001
Practice Address - Country:US
Practice Address - Phone:615-898-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer