Provider Demographics
NPI:1104234483
Name:DAVIS, JORDAN N (PT, DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:N
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7327 N 166TH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-2833
Mailing Address - Country:US
Mailing Address - Phone:402-431-2026
Mailing Address - Fax:531-201-0301
Practice Address - Street 1:20117 FRANKLIN CIR STE 100
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-6578
Practice Address - Country:US
Practice Address - Phone:402-431-2026
Practice Address - Fax:531-201-0301
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist