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NPI Code Detail

MEDICARE: JORDAN PHILIP WAUGH DPT

MEDICARE: JORDAN PHILIP WAUGH 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 TherapistP20405NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P20405OTHERNCPT LICENSE

General Provider Information

NPI Number : 1295309300
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN PHILIP WAUGH DPT
Provider Business Mailing Address
First Line : PO BOX 5105
Second Line :
City : BELFAST
State : ME
Zip : 04915-5100
Country : US
Telephone Number : 252-726-1802
Fax Number : 252-726-1805
Provider Business Practice Location Address
First Line : 2145 COUNTRY CLUB RD STE 200
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-2404
Country : US
Telephone Number : 252-726-1802
Fax Number : 252-726-1805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2021
Last Update Date : 01/15/2024

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Directions to “ JORDAN PHILIP WAUGH DPT” Practice Location

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