MEDICARE: BRADLEY DEAN JORDAN OTR CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number
1	2251S0007X	Sports Physical Therapist	915917
2	2251X0800X	Orthopedic Physical Therapist	915917
3	225X00000X	Occupational Therapist	915917

General Provider Information

NPI Number	:	1972585560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY DEAN JORDAN OTR CHT

Provider Business Mailing Address
First Line	:	1330 QUAIL LAKE LOOP
Second Line	:	SUITE 100 PT WORKS PC CHEYENNE MOUNTAIN CLINIC
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4651
Country	:	US
Telephone Number	:	719-579-0230
Fax Number	:	719-579-0277

Provider Business Practice Location Address
First Line	:	2375 TELSTAR DRIVE
Second Line	:	SUITE 110 PT WORKS PC BRIARGATE CLINIC
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1029
Country	:	US
Telephone Number	:	719-590-7777
Fax Number	:	719-590-7121

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	09/11/2025

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Directions to “ BRADLEY DEAN JORDAN OTR CHT” Practice Location

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