Healthcare Provider Details

I. General information

NPI: 1104234483
Provider Name (Legal Business Name): JORDAN N DAVIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN N DAVIS

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20117 FRANKLIN CIR STE 100
ELKHORN NE
68022-6578
US

IV. Provider business mailing address

7327 N 166TH ST
BENNINGTON NE
68007-2833
US

V. Phone/Fax

Practice location:
  • Phone: 402-431-2026
  • Fax: 531-201-0301
Mailing address:
  • Phone: 402-431-2026
  • Fax: 531-201-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3363
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: