Provider Demographics
NPI:1316466212
Name:JORDAN, JESSICA (LMT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 76 RD
Mailing Address - Street 2:
Mailing Address - City:BERKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:13736-2007
Mailing Address - Country:US
Mailing Address - Phone:607-351-0934
Mailing Address - Fax:
Practice Address - Street 1:1121 76 RD
Practice Address - Street 2:
Practice Address - City:BERKSHIRE
Practice Address - State:NY
Practice Address - Zip Code:13736-2007
Practice Address - Country:US
Practice Address - Phone:607-351-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029889-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist