Provider Demographics
NPI:1578111985
Name:JORDAN, JOSHUA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5671
Mailing Address - Country:US
Mailing Address - Phone:212-353-8693
Mailing Address - Fax:
Practice Address - Street 1:29 CRAFTS ST STE 570
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1282
Practice Address - Country:US
Practice Address - Phone:617-965-8070
Practice Address - Fax:617-965-8071
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist