Provider Demographics
NPI:1851066658
Name:HERWIG, JORDYN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JORDYN
Middle Name:
Last Name:HERWIG
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 1:1060 LYLE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8403
Mailing Address - Country:US
Mailing Address - Phone:678-787-0784
Mailing Address - Fax:
Practice Address - Street 1:1951 CLEMENTS FERRY RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8325
Practice Address - Country:US
Practice Address - Phone:843-990-5262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist