Healthcare Provider Details

I. General information

NPI: 1083248462
Provider Name (Legal Business Name): JORDAN NICOLE LINDON DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 GARDEN WAY
EDGEWOOD KY
41017
US

IV. Provider business mailing address

520 GARDEN WAY
EDGEWOOD KY
41017-3387
US

V. Phone/Fax

Practice location:
  • Phone: 859-835-4373
  • Fax:
Mailing address:
  • Phone: 859-835-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT-007908
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0017143
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007908
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: