Provider Demographics
NPI:1184438343
Name:JORDAN, KOEHNA KATHLEENE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KOEHNA
Middle Name:KATHLEENE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KOEHNA
Other - Middle Name:K
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 CLAPP ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3112
Mailing Address - Country:US
Mailing Address - Phone:336-380-6534
Mailing Address - Fax:
Practice Address - Street 1:111 KNOX WAY STE 112
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-6615
Practice Address - Country:US
Practice Address - Phone:919-929-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist