Provider Demographics
NPI:1699221804
Name:WILKINS, JORDAN THRASHER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:THRASHER
Last Name:WILKINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:KATE
Other - Last Name:THRASHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:119 CANAL ST STE 104
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4094
Practice Address - Country:US
Practice Address - Phone:912-330-8444
Practice Address - Fax:912-330-8844
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist