Healthcare Provider Details

I. General information

NPI: 1720673114
Provider Name (Legal Business Name): JORDAN WOPINSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 PARK RD
CHARLOTTE NC
28209-2377
US

IV. Provider business mailing address

910 WALNUT AVE APT 201
CHARLOTTE NC
28208-4670
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-4834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21916
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: