Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1073034567 |
---|---|
Provider Name | Kristina Jorden |
First Address | Saint Clairsville, OH 43950-8407 |
Second Address | Wheeling, WV 26003-6261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 05/07/2017 |