Provider Demographics
NPI:1972585560
Name:JORDAN, BRADLEY DEAN (OTR CHT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DEAN
Last Name:JORDAN
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Gender:M
Credentials:OTR CHT
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Mailing Address - Street 1:1330 QUAIL LAKE LOOP
Mailing Address - Street 2:SUITE 100 PT WORKS PC CHEYENNE MOUNTAIN CLINIC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-579-0230
Mailing Address - Fax:719-579-0277
Practice Address - Street 1:2375 TELSTAR DRIVE
Practice Address - Street 2:SUITE 110 PT WORKS PC BRIARGATE CLINIC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1029
Practice Address - Country:US
Practice Address - Phone:719-590-7777
Practice Address - Fax:719-590-7121
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
9159172251S0007X, 2251X0800X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
448808Medicare ID - Type Unspecified