Basic Information
| Provider Information | |||||||||
| NPI: | 1730385774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | BOBBI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2984 EVANS RD | ||||||||
| Address2: | |||||||||
| City: | LEON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251238600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045932873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 PINECREST DR | ||||||||
| Address2: | |||||||||
| City: | GALLIPOLIS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456311347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404467112 | ||||||||
| FaxNumber: | 7404469088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 05246 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.