Provider Demographics
NPI:1609392901
Name:CHANG, JORDAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
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 1:5690 W CHANDLER BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3356
Mailing Address - Country:US
Mailing Address - Phone:480-878-7425
Mailing Address - Fax:480-207-1025
Practice Address - Street 1:5690 W CHANDLER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226
Practice Address - Country:US
Practice Address - Phone:480-878-7425
Practice Address - Fax:480-207-1025
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-02-14
Deactivation Date:2017-12-29
Deactivation Code:
Reactivation Date:2018-01-08
Provider Licenses
StateLicense IDTaxonomies
AZ13215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist