Provider Demographics
NPI:1427381813
Name:JORDAN PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:JORDAN PHYSICAL THERAPY CENTER
Other - Org Name:HOT SPRINGS SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PCC/CREDENTIALING SPECIALIST NC/AR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:704-879-2532
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-7800
Mailing Address - Fax:704-824-2853
Practice Address - Street 1:2278 ALBERT PIKE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4157
Practice Address - Country:US
Practice Address - Phone:501-767-0808
Practice Address - Fax:501-767-0832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORDAN PHYSICAL THERAPY DBA HOT SPRINGS SPORTS MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-16
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes273Y00000XHospital UnitsRehabilitation Unit
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty