Provider Demographics
NPI:1265070262
Name:JORDAN, BRITTANY
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:JORDAN
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 1:56100 NW SCOFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:OR
Mailing Address - Zip Code:97109
Mailing Address - Country:US
Mailing Address - Phone:971-777-0308
Mailing Address - Fax:
Practice Address - Street 1:2545 SW TERWILLIGER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-6302
Practice Address - Country:US
Practice Address - Phone:503-299-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09721225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant