Provider Demographics
NPI:1578784195
Name:JORDAN, JEFFREY NEIL (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:NEIL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HOSPITAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538
Mailing Address - Country:US
Mailing Address - Phone:337-828-3600
Mailing Address - Fax:337-828-4557
Practice Address - Street 1:1600 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538
Practice Address - Country:US
Practice Address - Phone:337-828-3600
Practice Address - Fax:337-828-4557
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CC66Medicare ID - Type Unspecified