Healthcare Provider Details

I. General information

NPI: 1629319439
Provider Name (Legal Business Name): MICHAEL C JORDHAMO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 IDLEWILD AVE STE 2
CORNWALL ON HUDSON NY
12520-1155
US

IV. Provider business mailing address

1 IDLEWILD AVE STE 2
CORNWALL ON HUDSON NY
12520-1155
US

V. Phone/Fax

Practice location:
  • Phone: 845-501-4171
  • Fax: 845-314-8714
Mailing address:
  • Phone: 845-501-4171
  • Fax: 845-314-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046919
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-019755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: