Provider Demographics
NPI:1982437885
Name:NORTHRUP, JORDAN JAMES (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JAMES
Last Name:NORTHRUP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8818 CENTRE PARK DR STE 111
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2231
Mailing Address - Country:US
Mailing Address - Phone:443-545-8549
Mailing Address - Fax:
Practice Address - Street 1:8818 CENTRE PARK DR STE 111
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2231
Practice Address - Country:US
Practice Address - Phone:443-545-8549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist