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General NPI Number Information
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NPI Number | 1972790822
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Entity Type | Individual
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Provider Name | JEDD ALAN THORDERSON PT
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 4340 KINGS WAY
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City | VALDOSTA
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State | GA
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Zip | 31602-6921
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Country | US
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Telephone | 229-333-9736
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | FORTSON
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State | GA
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Zip | 31808-0370
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Country | US
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Telephone | 706-494-3171
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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 | PT007933
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number | PT007933
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License Number State | GA
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