Provider Demographics
NPI:1902869613
Name:JORDAN, ROBERT DEE (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 AIRPORT RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-2117
Mailing Address - Country:US
Mailing Address - Phone:501-781-2701
Mailing Address - Fax:501-781-2702
Practice Address - Street 1:1880 AIRPORT RD STE C
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-2117
Practice Address - Country:US
Practice Address - Phone:501-781-2701
Practice Address - Fax:501-781-2702
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR960225100000X, 225100000X
82302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S424OtherBCBS
AR190173721Medicaid
AR1902869613OtherNPI
AR1902869613OtherNPI
AR55424OtherBCBS