Provider Demographics
NPI:1740929934
Name:PEOPLES, JORDAN AMANDA (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:AMANDA
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5778 OLEKA PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1938
Mailing Address - Country:US
Mailing Address - Phone:714-837-7693
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DR STE 420
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-5403
Practice Address - Country:US
Practice Address - Phone:808-498-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist