Provider Demographics
NPI:1306484100
Name:FEARLESS PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:FEARLESS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARQUIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-504-4530
Mailing Address - Street 1:9 MADISON CHASE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6115
Mailing Address - Country:US
Mailing Address - Phone:910-280-1427
Mailing Address - Fax:
Practice Address - Street 1:9 MADISON CHASE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6115
Practice Address - Country:US
Practice Address - Phone:910-280-1427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy