MEDICARE: JORDAN PHYSICAL THERAPY CENTER INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE9702	OTHER		PALMETTO GBA
2	693682	OTHER		ACN
3	ZZZ64862Z	OTHER	CA	BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1730260407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN PHYSICAL THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	42080 STATE STREET
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5173
Country	:	US
Telephone Number	:	760-568-2894
Fax Number	:	760-346-4179

Provider Business Practice Location Address
First Line	:	42080 STATE STREET
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5173
Country	:	US
Telephone Number	:	760-568-2894
Fax Number	:	760-568-2894

Authorized Official
Title or Position	:	OWNER
Name	:	DANNY JORDAN
Credential	:	MPT
Telephone Number	:	760-568-2894

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	04/20/2008

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