Provider Demographics
NPI:1841780426
Name:WHITAKER, JORDON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JORDON
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NE SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-6405
Mailing Address - Country:US
Mailing Address - Phone:541-613-8814
Mailing Address - Fax:
Practice Address - Street 1:4811 MEADOWS RD STE 105
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2542
Practice Address - Country:US
Practice Address - Phone:503-387-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist