Healthcare Provider Details

I. General information

NPI: 1972585560
Provider Name (Legal Business Name): BRADLEY DEAN JORDAN OTR CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 TELSTAR DRIVE SUITE 110 PT WORKS PC BRIARGATE CLINIC
COLORADO SPRINGS CO
80920-1029
US

IV. Provider business mailing address

1330 QUAIL LAKE LOOP SUITE 100 PT WORKS PC CHEYENNE MOUNTAIN CLINIC
COLORADO SPRINGS CO
80906-4651
US

V. Phone/Fax

Practice location:
  • Phone: 719-590-7777
  • Fax: 719-590-7121
Mailing address:
  • Phone: 719-579-0230
  • Fax: 719-579-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number915917
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number915917
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number915917
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: