Provider Demographics
NPI:1205523024
Name:PORTERFIELD, JORDAN LYNN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNN
Last Name:PORTERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 BLAIR ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1508
Mailing Address - Country:US
Mailing Address - Phone:724-620-7122
Mailing Address - Fax:
Practice Address - Street 1:1021 BLAIR ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-1508
Practice Address - Country:US
Practice Address - Phone:724-620-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer