Provider Demographics
NPI:1508540451
Name:JORDAN, MARK GREGORY (MS, CEP, CCRP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:MS, CEP, CCRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 MELBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2846
Mailing Address - Country:US
Mailing Address - Phone:412-576-8490
Mailing Address - Fax:412-623-2584
Practice Address - Street 1:5200 CENTRE AVE STE 503
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1320
Practice Address - Country:US
Practice Address - Phone:412-623-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist