Provider Demographics
NPI:1487009528
Name:JORDAN, PAULA (DPT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E WADSWORTH PARK DR STE 230
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8096
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:56 MERCER ST APT 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3516
Practice Address - Country:US
Practice Address - Phone:973-262-8407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5989225100000X
FLPT37769225100000X
IL070026343225100000X
RIPT03460225100000X
MI5501021634225100000X
NY048341225100000X
KS11-06931225100000X
PAPT030075225100000X
ALPTH10647225100000X
NJ40QA01663500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist