Provider Demographics
NPI:1720556624
Name:KAREIS, JORDAN GAILLARD (PT, DPT, CERT DN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:GAILLARD
Last Name:KAREIS
Suffix:
Gender:F
Credentials:PT, DPT, CERT DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COURTYARD TER
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4569
Mailing Address - Country:US
Mailing Address - Phone:770-375-0775
Mailing Address - Fax:
Practice Address - Street 1:114 COURTYARD TER
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4569
Practice Address - Country:US
Practice Address - Phone:770-375-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
GAPT013789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist