Provider Demographics
NPI:1891233193
Name:JORDAN, BARBARA (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7329 SECREST CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7620
Mailing Address - Country:US
Mailing Address - Phone:720-777-4485
Mailing Address - Fax:
Practice Address - Street 1:13123 EAST 16TH AVENUE,
Practice Address - Street 2:BOX 295
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205
Practice Address - Country:US
Practice Address - Phone:720-777-4485
Practice Address - Fax:720-777-6563
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL00066572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics