MEDICARE: FEARLESS PHYSICAL THERAPY PLLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1306484100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEARLESS PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	9 MADISON CHASE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6115
Country	:	US
Telephone Number	:	910-280-1427
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 MADISON CHASE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6115
Country	:	US
Telephone Number	:	910-280-1427
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. MARQUIS N JORDAN
Credential	:	DPT
Telephone Number	:	757-504-4530

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

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