MEDICARE: JORDAN WASHBURN

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1154964831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN WASHBURN

Provider Business Mailing Address
First Line	:	1133 E 770 S
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-4515
Country	:	US
Telephone Number	:	435-817-1711
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 E 1200 S
Second Line	:
City	:	HEBER CITY
State	:	UT
Zip	:	84032-4497
Country	:	US
Telephone Number	:	435-654-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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Directions to “ JORDAN WASHBURN ” Practice Location

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