Healthcare Provider Details

I. General information

NPI: 1396169603
Provider Name (Legal Business Name): JORDAN BRANDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 SW STRATUS ST STE 220
BEAVERTON OR
97008-7130
US

IV. Provider business mailing address

541 NE 20TH AVE STE 225
PORTLAND OR
97232-2895
US

V. Phone/Fax

Practice location:
  • Phone: 503-863-5880
  • Fax: 503-863-5881
Mailing address:
  • Phone: 503-963-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60454
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: