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General NPI Number Information
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NPI Number | 1235597246
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Entity Type | Individual
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Provider Name | JORDAN TAYLOR FONTENOT PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/04/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1212 W PARMER LN STE E
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City | AUSTIN
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State | TX
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Zip | 78727-4657
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Country | US
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Telephone | 512-670-3238
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Fax |
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Provider Business Mailing Address
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Address Line | 17325 BELL NORTH DR SUITE 2-B
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City | SCHERTZ
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State | TX
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Zip | 78154-3368
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Country | US
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Telephone | 888-590-4002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1271201
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License Number State | TX
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