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NPI Code Detail

MEDICARE: GRANT JORDAN

MEDICARE: GRANT JORDAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist27416OR

General Provider Information

NPI Number : 1134831258
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRANT JORDAN
Provider Business Mailing Address
First Line : 63265 SILVIS RD
Second Line :
City : BEND
State : OR
Zip : 97701-9743
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 335 NE 4TH ST
Second Line :
City : BEND
State : OR
Zip : 97701-5162
Country : US
Telephone Number : 541-668-7506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2022
Last Update Date : 12/20/2022

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Directions to “ GRANT JORDAN ” Practice Location

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