Healthcare Provider Details

I. General information

NPI: 1457825077
Provider Name (Legal Business Name): JORDAN LEA FLEMING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E ENTERPRISE AVE STE 113
APPLETON WI
54913-7862
US

IV. Provider business mailing address

2105 E ENTERPRISE AVE STE 113
APPLETON WI
54913-7862
US

V. Phone/Fax

Practice location:
  • Phone: 920-991-2561
  • Fax: 920-991-2563
Mailing address:
  • Phone: 920-991-2561
  • Fax: 920-991-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT295955
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: