Provider Demographics
NPI:1578216644
Name:SPILLER, JORDAN KIMBILLEE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:KIMBILLEE
Last Name:SPILLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24666 HAYMOW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8290
Mailing Address - Country:US
Mailing Address - Phone:248-567-9050
Mailing Address - Fax:
Practice Address - Street 1:29255 NORTHWESTERN HWY STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5742
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:248-353-1211
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501021641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist