Healthcare Provider Details

I. General information

NPI: 1780280859
Provider Name (Legal Business Name): JORDAN GELMAN PTA, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE STE 200
PAOLI PA
19301-1763
US

IV. Provider business mailing address

79 HARRISTOWN RD
PARADISE PA
17562-9636
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-3166
  • Fax:
Mailing address:
  • Phone: 717-368-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: