Provider Demographics
NPI:1841892064
Name:SPENNATO, JORDAN (DPT)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:SPENNATO
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 1:6303 DURANTA CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7755
Mailing Address - Country:US
Mailing Address - Phone:512-517-7191
Mailing Address - Fax:
Practice Address - Street 1:3030 RANDOLPH RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1365
Practice Address - Country:US
Practice Address - Phone:704-512-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1338471225100000X
NCP20114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist