Provider Demographics
NPI:1558817353
Name:WASHINGTON, JORDAN DAVID (PHYSICAL THERASPIST)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:DAVID
Last Name:WASHINGTON
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Gender:M
Credentials:PHYSICAL THERASPIST
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Mailing Address - Street 1:3908 VALLEY AVENUR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566
Mailing Address - Country:US
Mailing Address - Phone:925-417-8055
Mailing Address - Fax:925-417-8881
Practice Address - Street 1:3908 VALLEY AVENUR
Practice Address - Street 2:SUITE B
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566
Practice Address - Country:US
Practice Address - Phone:925-417-8055
Practice Address - Fax:925-417-8881
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPT291550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist