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General NPI Number Information
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NPI Number | 1568904886
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Entity Type | Individual
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Provider Name | JORDAN THOMAS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 1705 STEVENS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40205-1044
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Country | US
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Telephone | 502-451-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 CATHERINE DR
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City | CRESTWOOD
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State | KY
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Zip | 40014-9559
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Country | US
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Telephone | 270-302-3956
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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 | 006915
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License Number State | KY
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