Healthcare Provider Details

I. General information

NPI: 1922916154
Provider Name (Legal Business Name): JORDAN SMITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ROOSEVELT RD
GLEN ELLYN IL
60137-5806
US

IV. Provider business mailing address

1315 ANTIGO TRL
CAROL STREAM IL
60188-9041
US

V. Phone/Fax

Practice location:
  • Phone: 630-984-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: