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NPI Code Detail

MEDICARE: JORDAN LEVI WRIGHTSMAN RBT

MEDICARE: JORDAN LEVI WRIGHTSMAN RBT
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
1106S00000XBehavior TechnicianRBT-19-98092IN

General Provider Information

NPI Number : 1366054520
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN LEVI WRIGHTSMAN RBT
Provider Business Mailing Address
First Line : 7425 WESTFIELD BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46240-3056
Country : US
Telephone Number : 317-918-2698
Fax Number :
Provider Business Practice Location Address
First Line : 29101 N STATE ROAD 19
Second Line :
City : ATLANTA
State : IN
Zip : 46031-9443
Country : US
Telephone Number : 317-918-6289
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2020
Last Update Date : 02/14/2025

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