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General NPI Number Information
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NPI Number | 1336787522
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Entity Type | Individual
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Provider Name | JORDAN KEITH SPADY DPT
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Gender | Male
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 32819 YUCAIPA BLVD
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City | YUCAIPA
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State | CA
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Zip | 92399-1944
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Country | US
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Telephone | 909-797-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 25335 LANE ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2310
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Country | US
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Telephone | 817-371-2526
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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 | PT295345
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License Number State | CA
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