Basic Information
| Provider Information | |||||||||
| NPI: | 1215338033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASLEY | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FREEMAN | ||||||||
| OtherFirstName: | JORDAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 61 E SIDE SQ | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615202603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349705 | ||||||||
| FaxNumber: | 6182570665 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 GRIFFIN AVE | ||||||||
| Address2: | |||||||||
| City: | PEKIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615546246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3093474277 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2014 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.