Healthcare Provider Details

I. General information

NPI: 1780816850
Provider Name (Legal Business Name): JORDAN BIRKHEAD CUENIN PT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN BIRKHEAD CUENIN

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 HIGHWAY 153
GREENVILLE SC
29611-7516
US

IV. Provider business mailing address

3611 HIGHWAY 153
GREENVILLE SC
29611-7516
US

V. Phone/Fax

Practice location:
  • Phone: 864-210-9625
  • Fax:
Mailing address:
  • Phone: 864-210-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8078
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: