Provider Demographics
NPI:1639528094
Name:SCHAFFER, JORDAN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N 4TH ST APT 151
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4483
Mailing Address - Country:US
Mailing Address - Phone:605-460-0726
Mailing Address - Fax:480-275-6310
Practice Address - Street 1:5353 N 16TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3224
Practice Address - Country:US
Practice Address - Phone:602-826-0037
Practice Address - Fax:480-275-6310
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122592251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic