Provider Demographics
NPI:1790184463
Name:EISENHARD, JORDYN (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:EISENHARD
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MONTLAKE BLVD
Mailing Address - Street 2:BOX 354060
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 MONTLAKE BLVD
Practice Address - Street 2:BOX 354060
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0007
Practice Address - Country:US
Practice Address - Phone:610-246-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer