Healthcare Provider Details

I. General information

NPI: 1851786297
Provider Name (Legal Business Name): JORDAYN JARGSTORF PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S CREASY LN STE 100
LAFAYETTE IN
47905-7433
US

IV. Provider business mailing address

PO BOX 4699
LAFAYETTE IN
47903-4699
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-5552
  • Fax: 765-449-1054
Mailing address:
  • Phone: 765-446-5417
  • Fax: 765-446-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013748
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: