Provider Demographics
NPI:1023793502
Name:JORDAN, JOSHUA (DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
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 1:753 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-9651
Mailing Address - Country:US
Mailing Address - Phone:610-657-0254
Mailing Address - Fax:
Practice Address - Street 1:2010 LEVICK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2928
Practice Address - Country:US
Practice Address - Phone:215-537-4755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02232600225100000X
PAPT031528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist