Provider Demographics
NPI:1386315968
Name:STEPHENSON, JORDAN-LEE (PTA)
Entity type:Individual
Prefix:
First Name:JORDAN-LEE
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 VILLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3533
Mailing Address - Country:US
Mailing Address - Phone:620-330-3646
Mailing Address - Fax:
Practice Address - Street 1:615 PRICE AVE
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:KS
Practice Address - Zip Code:67748-2048
Practice Address - Country:US
Practice Address - Phone:785-672-8109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03438225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant