Doctor Name: | JORDAN BLOUNT RICHARDSON |
NPI Number: | 1205080223 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT |
License Number: | 8444 |
Business Practice Address: | 3278 Mitchell Blvd Moody Afb, GA - 316991500 |
Business Phone Number: | 2292571459 |
Business Fax Number: | |
Mailing Address: | 3278 Mitchell Blvd, MOODY AFB |
State: | GA |
Postal Code: | 316991500 |
Phone Number: | 2292571459 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2008 |
NPI Last Update Date: | 04/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 8444 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |