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NPI Code Detail

MEDICARE: JORDAN ROSS PT

MEDICARE: JORDAN ROSS PT
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 Therapist4819OK

General Provider Information

NPI Number : 1205235439
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN ROSS PT
Provider Business Mailing Address
First Line : 2630 OKLAHOMA AVE
Second Line :
City : WOODWARD
State : OK
Zip : 73801-4010
Country : US
Telephone Number : 580-256-2102
Fax Number : 580-256-1410
Provider Business Practice Location Address
First Line : 2630 OKLAHOMA AVE
Second Line :
City : WOODWARD
State : OK
Zip : 73801-4010
Country : US
Telephone Number : 580-256-2102
Fax Number : 580-256-1410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2014
Last Update Date : 11/18/2019

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