Provider Demographics
NPI:1558609396
Name:JORDAN, ALAN KELLY (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:KELLY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BRIDGE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-2129
Mailing Address - Country:US
Mailing Address - Phone:717-884-9568
Mailing Address - Fax:
Practice Address - Street 1:337 BRIDGE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-2129
Practice Address - Country:US
Practice Address - Phone:717-884-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00030500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist