Healthcare Provider Details

I. General information

NPI: 1609224765
Provider Name (Legal Business Name): CHRISTIAN A JORNS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FODEN RD
SOUTH PORTLAND ME
04106-1718
US

IV. Provider business mailing address

100 GANNETT DR STE C
SOUTH PORTLAND ME
04106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-780-8860
  • Fax:
Mailing address:
  • Phone: 207-828-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4655
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: