Provider Demographics
NPI:1295244739
Name:SONANDER-DANGERFIELD, JORDAN (DPT)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SONANDER-DANGERFIELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:DANGERFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 W EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1030
Practice Address - Country:US
Practice Address - Phone:408-523-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA294099OtherPT LICENSE