Provider Demographics
NPI:1558763391
Name:HARPER, JORDAN KEITH (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:KEITH
Last Name:HARPER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 MARKET RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6828
Mailing Address - Country:US
Mailing Address - Phone:804-695-6326
Mailing Address - Fax:
Practice Address - Street 1:4150 MARKET RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-6828
Practice Address - Country:US
Practice Address - Phone:804-695-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant