=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760398200
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE JORDON MT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2026
-----------------------------------------------------
Last Update Date | 08/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8145 KENNEDY AVE
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-803-6630
-----------------------------------------------------
Fax | 219-937-7237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3426 PENINSULA DR APT 16
-----------------------------------------------------
City | PORTAGE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46368-4274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-256-4226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT20902178
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------