Provider Demographics
NPI:1881003804
Name:MCILVAIN, JORDON
Entity Type:Individual
Prefix:
First Name:JORDON
Middle Name:
Last Name:MCILVAIN
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 1:10 COOPER PL APT 1
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2110
Mailing Address - Country:US
Mailing Address - Phone:540-454-2135
Mailing Address - Fax:
Practice Address - Street 1:326 HIGHWAY 133 STE 60
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2536
Practice Address - Country:US
Practice Address - Phone:540-454-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist