Healthcare Provider Details

I. General information

NPI: 1578484861
Provider Name (Legal Business Name): JORDAN ANNA SPRATLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN ANNA OCONNOR

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

IV. Provider business mailing address

11023 GA HIGHWAY 80 N
NORWOOD GA
30821-3421
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-5255
  • Fax:
Mailing address:
  • Phone: 706-699-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA004763
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: