Provider Demographics
NPI:1184054199
Name:APPLEBY, JORDON
Entity type:Individual
Prefix:
First Name:JORDON
Middle Name:
Last Name:APPLEBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3836
Mailing Address - Country:US
Mailing Address - Phone:419-651-3794
Mailing Address - Fax:
Practice Address - Street 1:1600 CRIDER RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-9268
Practice Address - Country:US
Practice Address - Phone:419-589-7611
Practice Address - Fax:419-589-3403
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08957225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant