Provider Demographics
NPI:1689955759
Name:WALDRIP, JORDAN BOLDT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BOLDT
Last Name:WALDRIP
Suffix:
Gender:F
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 1:5000 SCHERTZ PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1457
Mailing Address - Country:US
Mailing Address - Phone:210-804-5672
Mailing Address - Fax:
Practice Address - Street 1:5000 SCHERTZ PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1457
Practice Address - Country:US
Practice Address - Phone:210-804-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1208610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist