Provider Demographics
NPI:1851847636
Name:DAVIES, JORDAN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:NY
Mailing Address - Zip Code:14065-9764
Mailing Address - Country:US
Mailing Address - Phone:716-353-2395
Mailing Address - Fax:
Practice Address - Street 1:8746 ERIE RD STE A
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9620
Practice Address - Country:US
Practice Address - Phone:716-549-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010572225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant