Healthcare Provider Details

I. General information

NPI: 1679018451
Provider Name (Legal Business Name): JORDAN EMERENCE ENGLER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E KING ST
SEAFORD DE
19973-3505
US

IV. Provider business mailing address

31774 KENILWORTH DR
SALISBURY MD
21804-1834
US

V. Phone/Fax

Practice location:
  • Phone: 302-628-3000
  • Fax:
Mailing address:
  • Phone: 410-430-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0001198
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: