Provider Demographics
NPI:1457795056
Name:JORDAN, DANIEL L (CPTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:M
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 E 29TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3405
Mailing Address - Country:US
Mailing Address - Phone:316-636-1111
Mailing Address - Fax:316-858-3971
Practice Address - Street 1:7373 E 29TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3405
Practice Address - Country:US
Practice Address - Phone:316-636-1111
Practice Address - Fax:316-858-3971
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS141987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant