Provider Demographics
NPI:1659510816
Name:JORDAN, PATRICK BURGERMEISTER (LMP)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BURGERMEISTER
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 NE MCWILLIAMS RD
Mailing Address - Street 2:B
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3138
Mailing Address - Country:US
Mailing Address - Phone:360-551-6982
Mailing Address - Fax:
Practice Address - Street 1:1175 NE MCWILLIAMS RD
Practice Address - Street 2:B
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3138
Practice Address - Country:US
Practice Address - Phone:360-551-6982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60042460225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist