| Doctor Name: | FREDA MAE DIASANTA JORDAN |
| NPI Number: | 1053696476 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPT |
| License Number: | 032857 |
| Business Practice Address: | 1900 10th St Silvis, IL - 612821909 |
| Business Phone Number: | 3092781537 |
| Business Fax Number: | |
| Mailing Address: | 10500 Wayzata Blvd, HOPKINS |
| State: | MN |
| Postal Code: | 553051511 |
| Phone Number: | 9522241919 |
| Fax Number: | |
| NPI Enumeration Date: | 10/17/2011 |
| NPI Last Update Date: | 12/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 032857 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |