Provider Demographics
NPI:1528120722
Name:JORDAN, REBECCA CLAIRE (PT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:CLAIRE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:CLAIRE
Other - Last Name:WESTPHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:213 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3637
Mailing Address - Country:US
Mailing Address - Phone:908-979-0555
Mailing Address - Fax:
Practice Address - Street 1:KESSLER 141 ROUTE 46 EAST
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-691-4244
Practice Address - Fax:973-448-9635
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA003562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist