Provider Demographics
NPI:1386156222
Name:BLOOD, JORDYN M (ATC)
Entity type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:M
Last Name:BLOOD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:JORDYN
Other - Middle Name:MCKENNZIE
Other - Last Name:BLOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:5757 HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1776
Mailing Address - Country:US
Mailing Address - Phone:419-490-7005
Mailing Address - Fax:
Practice Address - Street 1:2801 W BANCROFT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-490-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000310072255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer