Provider Demographics
NPI:1437539046
Name:PHILLIPS, JORDAN PRICE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PRICE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:NAOMI
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:12755 S MUR LEN RD STE B1
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6804
Practice Address - Country:US
Practice Address - Phone:913-782-7734
Practice Address - Fax:913-782-7209
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011902225100000X
KS11-06055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist