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NPI Code Detail

MEDICARE: JORDAN COULON PT DPT PLLC

MEDICARE: JORDAN COULON PT DPT PLLC
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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1598241341
Entity Type Code : Organization
Provider Name (Legal Business Name) : JORDAN COULON PT DPT PLLC
Provider Business Mailing Address
First Line : 2606 LOMA DR
Second Line :
City : MIDLAND
State : TX
Zip : 79705-6614
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2606 LOMA DR
Second Line :
City : MIDLAND
State : TX
Zip : 79705-6614
Country : US
Telephone Number : 432-897-1199
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JORDAN COULON
Credential : DPT
Telephone Number : 432-889-9281
Provider Enumeration Date : 07/16/2018
Last Update Date : 07/16/2018

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