Provider Demographics
NPI:1396943981
Name:JORDRE, BECCA D (DPT)
Entity type:Individual
Prefix:
First Name:BECCA
Middle Name:D
Last Name:JORDRE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:MUELLERLEILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:440 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-1403
Practice Address - Country:US
Practice Address - Phone:605-741-0003
Practice Address - Fax:605-202-6414
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4992120OtherSOUTH DAKOTA BLUE CROSS BLUE SHIELD
SDS102540Medicare PIN