Provider Demographics
NPI:1578970794
Name:BILLINGS, JORDAN MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHELLE
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MICHELLE
Other - Last Name:NAFFZIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16504 FAIRBANKS RD N
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80651-9333
Mailing Address - Country:US
Mailing Address - Phone:970-433-1788
Mailing Address - Fax:
Practice Address - Street 1:6200 W 9TH ST UNIT 5
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4462
Practice Address - Country:US
Practice Address - Phone:970-301-4596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013375225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant