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General NPI Number Information
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NPI Number | 1801386735
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Entity Type | Individual
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Provider Name | JORDAN LEE
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Gender | Male
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 65 SHENANDOAH AVE STE 203
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City | DALEVILLE
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State | VA
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Zip | 24083-3205
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Country | US
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Telephone | 540-352-4304
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Fax | 540-591-7340
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Provider Business Mailing Address
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Address Line | 825 DAVIS ST STE B
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City | BLACKSBURG
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State | VA
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Zip | 24060-7009
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Country | US
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Telephone | 540-352-4304
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Fax | 504-591-7340
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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 | 2305211889
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License Number State | VA
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Taxonomy #2
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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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