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General NPI Number Information
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NPI Number | 1861808248
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Entity Type | Individual
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Provider Name | JORDAN REDDING LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 300 WASHINGTON AVE
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1438
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Country | US
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Telephone | 410-810-7495
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Fax |
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Provider Business Mailing Address
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Address Line | 125 PHILOSOPHERS TER UNIT 3
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City | CHESTERTOWN
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State | MD
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Zip | 21620-1625
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Country | US
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Telephone | 260-615-5198
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | A0000590
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License Number State | MD
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