MEDICARE: MR. EDWARD MATHEW JORDAN 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
1	225100000X	Physical Therapist	19052	MD

General Provider Information

NPI Number	:	1568469658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD MATHEW JORDAN PT

Provider Business Mailing Address
First Line	:	PO BOX 1859
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21802-1859
Country	:	US
Telephone Number	:	440-341-6520
Fax Number	:	410-341-6526

Provider Business Practice Location Address
First Line	:	32071 BEAVER RUN DR
Second Line	:	STE B
City	:	SALISBURY
State	:	MD
Zip	:	21804-1773
Country	:	US
Telephone Number	:	440-341-6520
Fax Number	:	410-341-6526

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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