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NPI Code Detail

MEDICARE: JORDAN LUKE GANTHER DPT

MEDICARE:   JORDAN LUKE GANTHER  DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist15412-24WI

General Provider Information

NPI Number : 1144897695
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN LUKE GANTHER DPT
Provider Business Mailing Address
First Line : 8800 W LINCOLN AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2400
Country : US
Telephone Number : 414-541-1118
Fax Number :
Provider Business Practice Location Address
First Line : 7708 W GOOD HOPE RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-4516
Country : US
Telephone Number : 414-541-1118
Fax Number : 414-541-3066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2021
Last Update Date : 06/04/2021

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Directions to “ JORDAN LUKE GANTHER DPT” Practice Location

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