Provider Demographics
NPI:1659813012
Name:KNOUSE, JORDAN LEEANN (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEEANN
Last Name:KNOUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEEANN
Other - Last Name:ISOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2216 BUENAVENTURA BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3838
Mailing Address - Country:US
Mailing Address - Phone:530-338-0002
Mailing Address - Fax:855-851-6199
Practice Address - Street 1:2216 BUENAVENTURA BLVD STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3838
Practice Address - Country:US
Practice Address - Phone:530-338-0002
Practice Address - Fax:855-851-6199
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT43184207V00000X, 208100000X
CA43184273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No273Y00000XHospital UnitsRehabilitation Unit