Provider Demographics
NPI:1679209894
Name:DREDGE, JORDAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:DREDGE
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 1:4220 LUCILE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6004
Mailing Address - Country:US
Mailing Address - Phone:402-327-9000
Mailing Address - Fax:402-327-9003
Practice Address - Street 1:4220 LUCILE DR STE 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6004
Practice Address - Country:US
Practice Address - Phone:402-327-9000
Practice Address - Fax:402-327-9003
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist