Provider Demographics
NPI:1760236533
Name:CORDELL, JAYDEN THOMAS
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:THOMAS
Last Name:CORDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W 69TH ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5622
Mailing Address - Country:US
Mailing Address - Phone:605-782-9436
Mailing Address - Fax:
Practice Address - Street 1:2101 W 69TH ST UNIT 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5622
Practice Address - Country:US
Practice Address - Phone:605-782-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant