Provider Demographics
NPI:1194140244
Name:DENEVE, JORDAN R (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:R
Last Name:DENEVE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:R
Other - Last Name:GALLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:850 43RD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:2300 53RD AVE STE LL02
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7565
Practice Address - Country:US
Practice Address - Phone:563-449-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020563225100000X
IA072794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA072794OtherPT LICENSE