Provider Demographics
NPI:1962179408
Name:WARE, JORDAN DELEANY (LAT)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:DELEANY
Last Name:WARE
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COUNTY ROAD 3541
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-4705
Mailing Address - Country:US
Mailing Address - Phone:682-270-1897
Mailing Address - Fax:
Practice Address - Street 1:318 FM 316 S
Practice Address - Street 2:
Practice Address - City:EUSTACE
Practice Address - State:TX
Practice Address - Zip Code:75124-2519
Practice Address - Country:US
Practice Address - Phone:903-425-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT78132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer