Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTH3810 | AL |
NPI | 1003211038 |
---|---|
Provider Name | Michelle D Jordan |
First Address | Florence, AL 35630-1768 |
Second Address | Florence, AL 35630-1768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2014 |
Last Update Date | 04/11/2014 |