Healthcare Provider Details

I. General information

NPI: 1912347535
Provider Name (Legal Business Name): JORDAN A ADAMS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 05/08/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 INDIANA AVE STE 4
RIVERSIDE CA
92503-5479
US

IV. Provider business mailing address

24630 WASHINGTON AVE STE 200
MURRIETA CA
92562-6177
US

V. Phone/Fax

Practice location:
  • Phone: 951-637-2320
  • Fax: 951-637-2321
Mailing address:
  • Phone: 951-696-9353
  • Fax: 951-973-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11016PT
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number292996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: