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General NPI Number Information
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NPI Number | 1952934283
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Entity Type | Individual
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Provider Name | JORDAN CARRILLO PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 527 GOTT RD
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City | ENID
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State | OK
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Zip | 73705-5105
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Country | US
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Telephone | 972-921-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 527 GOTT RD
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City | ENID
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State | OK
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Zip | 73705-5105
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Country | US
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Telephone |
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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 | 1328690
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License Number State | TX
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