MEDICARE: JENNIFER JORDAN PT, DPT, CCS

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
1	225100000X	Physical Therapist	PT60268529	WA

General Provider Information

NPI Number	:	1184560179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JORDAN PT, DPT, CCS

Provider Business Mailing Address
First Line	:	208 SOLOMON LOOP NW
Second Line	:
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-6085
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 SOLOMON LOOP NW
Second Line	:
City	:	EAST WENATCHEE
State	:	WA
Zip	:	98802-6085
Country	:	US
Telephone Number	:	425-466-4248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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