Provider Demographics
NPI:1649759820
Name:PARRISH, JORDAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:PARRISH
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 1:100 NE TUDOR RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5601
Mailing Address - Country:US
Mailing Address - Phone:816-554-6003
Mailing Address - Fax:
Practice Address - Street 1:100 NE TUDOR RD STE 110
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5601
Practice Address - Country:US
Practice Address - Phone:816-554-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist