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NPI Code Detail

MEDICARE: JORDAN SASIELA DPT

MEDICARE: JORDAN SASIELA 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
1225100000XPhysical Therapist2017003438MO
2225100000XPhysical TherapistPT60967216WA

General Provider Information

NPI Number : 1952945024
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN SASIELA DPT
Provider Business Mailing Address
First Line : 3105 COUNTRY KNOLL DR
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-6342
Country : US
Telephone Number : 636-696-6888
Fax Number :
Provider Business Practice Location Address
First Line : 2689 HOOVER AVE SE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-3013
Country : US
Telephone Number : 360-874-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2019
Last Update Date : 11/01/2019

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