Provider Demographics
NPI:1689858243
Name:JORDAN, ANN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1818
Mailing Address - Country:US
Mailing Address - Phone:781-331-2533
Mailing Address - Fax:781-340-1337
Practice Address - Street 1:574 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1818
Practice Address - Country:US
Practice Address - Phone:781-331-2533
Practice Address - Fax:781-340-1337
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT 43692251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics