Provider Demographics
NPI:1629480512
Name:WILLIAMS, JORDAN C (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 N SWITZER CANYON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4851
Mailing Address - Country:US
Mailing Address - Phone:928-440-3106
Mailing Address - Fax:928-438-6702
Practice Address - Street 1:460 N SWITZER CANYON DR STE 400
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4851
Practice Address - Country:US
Practice Address - Phone:928-440-3106
Practice Address - Fax:928-438-6702
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10915PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist