Provider Demographics
NPI:1447572698
Name:NOUGARET, JORDAN LEE (MS, ATC, VATL)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:NOUGARET
Suffix:
Gender:M
Credentials:MS, ATC, VATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 STANDPIPE ROAD
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3787
Mailing Address - Country:US
Mailing Address - Phone:540-846-8438
Mailing Address - Fax:
Practice Address - Street 1:132 STANDPIPE ROAD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701
Practice Address - Country:US
Practice Address - Phone:540-846-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260012992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer