Provider Demographics
NPI:1851388730
Name:IGNACIO, JORDAN ALMOSARA (PT)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:ALMOSARA
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 82ND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4718
Mailing Address - Country:US
Mailing Address - Phone:347-393-8539
Mailing Address - Fax:
Practice Address - Street 1:5354 82ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4718
Practice Address - Country:US
Practice Address - Phone:347-393-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026705-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist