Provider Demographics
NPI:1457838260
Name:GILES, JORDAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:GILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ELIZABETH
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 S BRIDGE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2702
Mailing Address - Country:US
Mailing Address - Phone:434-238-7945
Mailing Address - Fax:434-205-3242
Practice Address - Street 1:126 S BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2702
Practice Address - Country:US
Practice Address - Phone:434-238-7945
Practice Address - Fax:434-205-3242
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist