Provider Demographics
NPI:1780972596
Name:REED, JORDAN CHRISTOPHER (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:REED
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4323
Mailing Address - Country:US
Mailing Address - Phone:712-383-3758
Mailing Address - Fax:
Practice Address - Street 1:205 NE DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9616
Practice Address - Country:US
Practice Address - Phone:515-987-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist