MEDICARE: JORDAN COX 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
1	225100000X	Physical Therapist	2305212808	VA

General Provider Information

NPI Number	:	1295373066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN COX DPT

Provider Business Mailing Address
First Line	:	342 COLONIAL HILL DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4445
Country	:	US
Telephone Number	:	276-618-0326
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 RIVERSIDE DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4257
Country	:	US
Telephone Number	:	276-629-1772
Fax Number	:

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

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	12/12/2019

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