=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780425173
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDYN TONKINSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2024
-----------------------------------------------------
Last Update Date | 06/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 SE 172ND AVE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98684-9542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 136-088-2277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12109 NE 241ST CT
-----------------------------------------------------
City | BRUSH PRAIRIE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98606-7739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-903-1730
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------