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General NPI Number Information
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NPI Number | 1346006616
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Entity Type | Organization
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Legal Business Name | JP PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 1010 FRANKLIN ST
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City | OGDENSBURG
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State | NY
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Zip | 13669-3368
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Country | US
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Telephone | 315-528-0024
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Fax |
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Provider Business Mailing Address
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Address Line | 9745 STATE HIGHWAY 37
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City | OGDENSBURG
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State | NY
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Zip | 13669-4110
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Country | US
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Telephone | 315-528-0024
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Fax |
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Authorized Official
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Title or Position | PT/OWNER
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Name | JORDAN PEDERSEN
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Credential | PT
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Telephone | 315-528-0024
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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 |
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License Number State |
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