Provider Demographics
NPI:1790181089
Name:JORDAN, NILS (DPT)
Entity Type:Individual
Prefix:
First Name:NILS
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 N TENAYA WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1102
Mailing Address - Country:US
Mailing Address - Phone:702-240-2952
Mailing Address - Fax:702-243-0482
Practice Address - Street 1:2650 N TENAYA WAY
Practice Address - Street 2:SUITE 180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1102
Practice Address - Country:US
Practice Address - Phone:702-240-2952
Practice Address - Fax:702-243-0482
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist