Provider Demographics
NPI:1619257607
Name:JORDAN, REBECCA LYNNE (RMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:COMO
Mailing Address - State:CO
Mailing Address - Zip Code:80432-1019
Mailing Address - Country:US
Mailing Address - Phone:303-941-2237
Mailing Address - Fax:855-323-8837
Practice Address - Street 1:288 MAIN ST # 10
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-5014
Practice Address - Country:US
Practice Address - Phone:303-872-9058
Practice Address - Fax:855-323-8837
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3346225700000X
COMT0003346225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist