Healthcare Provider Details

I. General information

NPI: 1679402697
Provider Name (Legal Business Name): JADEN GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST STE 120
KING OF PRUSSIA PA
19406-1509
US

IV. Provider business mailing address

2005 GREENHILL RD
LANSDOWNE PA
19050-1013
US

V. Phone/Fax

Practice location:
  • Phone: 484-806-0044
  • Fax:
Mailing address:
  • Phone: 215-594-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE013971
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: