Provider Demographics
NPI:1003635889
Name:JORDAN, SCOTT J (DPT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1229
Mailing Address - Country:US
Mailing Address - Phone:908-894-8105
Mailing Address - Fax:
Practice Address - Street 1:187 COUNTY ROAD 519
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823-1900
Practice Address - Country:US
Practice Address - Phone:908-847-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02289500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist