Provider Demographics
NPI:1598717118
Name:JORDAN, DARRELL KEITH JR (PT)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:KEITH
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:427 CROWNE CREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5071
Mailing Address - Country:US
Mailing Address - Phone:937-902-7451
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VAMC - PHYSICAL THERAPY DEPT
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:919-416-5913
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.009570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist