Provider Demographics
NPI:1801310370
Name:COUTURE, JORDAN (PT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:COUTURE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6559
Mailing Address - Country:US
Mailing Address - Phone:207-873-9841
Mailing Address - Fax:207-873-9845
Practice Address - Street 1:15 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7997
Practice Address - Country:US
Practice Address - Phone:207-621-7500
Practice Address - Fax:207-621-7501
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT4924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist