Provider Demographics
NPI:1750598231
Name:MCAMMOND, JORDAN MARY (PT)
Entity type:Individual
Prefix:MISS
First Name:JORDAN
Middle Name:MARY
Last Name:MCAMMOND
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Gender:F
Credentials:PT
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Mailing Address - Street 1:8300 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3450
Mailing Address - Country:US
Mailing Address - Phone:919-846-9668
Mailing Address - Fax:919-846-9663
Practice Address - Street 1:414 GALLIMORE DAIRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9693
Practice Address - Country:US
Practice Address - Phone:336-665-8445
Practice Address - Fax:336-665-8446
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-05-27
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Provider Licenses
StateLicense IDTaxonomies
NC11247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC068TCOtherBCBS NC
NC068TCOtherBCBS NC