MEDICARE: JORDAN ELLIS ANDERSON 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	12334	LA

General Provider Information

NPI Number	:	1891628988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELLIS ANDERSON DPT

Provider Business Mailing Address
First Line	:	217 AMELIA ST
Second Line	:
City	:	DESTREHAN
State	:	LA
Zip	:	70047-5349
Country	:	US
Telephone Number	:	504-491-0286
Fax Number	:

Provider Business Practice Location Address
First Line	:	3713 N 16TH ST
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77632-4630
Country	:	US
Telephone Number	:	409-330-4005
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ JORDAN ELLIS ANDERSON DPT” Practice Location

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