Basic Information
| Provider Information | |||||||||
| NPI: | 1679018451 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ENGLER | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | EMERENCE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31774 KENILWORTH DR | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218041834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104308216 | ||||||||
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| Practice Location | |||||||||
| Address1: | 715 E KING ST | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199733505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026283000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2017 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | J2-0001198 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.