Healthcare Provider Details

I. General information

NPI: 1811414501
Provider Name (Legal Business Name): JORDAN CLOUSE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W 2ND ST STE 27
MESA AZ
85201-6563
US

IV. Provider business mailing address

245 W 2ND ST STE 27
MESA AZ
85201-6563
US

V. Phone/Fax

Practice location:
  • Phone: 480-420-9407
  • Fax: 480-281-5220
Mailing address:
  • Phone: 480-420-9407
  • Fax: 480-281-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13246
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: