Healthcare Provider Details

I. General information

NPI: 1366503518
Provider Name (Legal Business Name): TRACY W JORDAN L.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1668 NC HIGHWAY 16 S
TAYLORSVILLE NC
28681-6285
US

IV. Provider business mailing address

1668 NC HWY 16 SOUTH
TAYLORSVILLE NC
28681
US

V. Phone/Fax

Practice location:
  • Phone: 828-632-9736
  • Fax: 828-632-9544
Mailing address:
  • Phone: 828-632-9736
  • Fax: 828-632-9544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNC6896
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: