Provider Demographics
NPI:1700924198
Name:JORDAN, ANGELA MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-4636
Mailing Address - Country:US
Mailing Address - Phone:806-934-1283
Mailing Address - Fax:
Practice Address - Street 1:224 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3808
Practice Address - Country:US
Practice Address - Phone:806-935-7171
Practice Address - Fax:806-934-2225
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2008702225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant