Provider Demographics
NPI:1497292577
Name:EBLE, JORDAN (ACE/CPT, CIFT/NCPAD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:EBLE
Suffix:
Gender:F
Credentials:ACE/CPT, CIFT/NCPAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4162 148TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5164
Mailing Address - Country:US
Mailing Address - Phone:425-869-9506
Mailing Address - Fax:425-869-9482
Practice Address - Street 1:4162 148TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5164
Practice Address - Country:US
Practice Address - Phone:425-869-9506
Practice Address - Fax:425-869-9482
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner