Provider Demographics
NPI:1205501566
Name:HOWARD, JORDAN (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HOWARD
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 1:2524 PROMLAKE CT APT 7
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3155
Mailing Address - Country:US
Mailing Address - Phone:334-239-9316
Mailing Address - Fax:
Practice Address - Street 1:1615 WINDSOR HILL CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-0168
Practice Address - Country:US
Practice Address - Phone:334-239-9316
Practice Address - Fax:334-239-9319
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist