Provider Demographics
NPI:1184298895
Name:RAINWATER, JORDAN CAROLINE (PT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CAROLINE
Last Name:RAINWATER
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 1:2625 ZOYSIA LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8462
Mailing Address - Country:US
Mailing Address - Phone:479-459-7771
Mailing Address - Fax:
Practice Address - Street 1:8101 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1104
Practice Address - Country:US
Practice Address - Phone:702-605-5263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4864225100000X
COCP007628T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist