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Organization
RESILIENT PHYSIOTHERAPY
Active
Organization
RESILIENT PHYSIOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORDAN SHETTLE PT, DPT (DOCTORATE OF PHYSICAL THERAPY)
(717) 817-4308
Entity
Organization
Contact information
Practice address
8303 PULASKI HWY, BALTIMORE, MD 21237-2962
(717) 817-4308
Mailing address
6221 GREENLEIGH AVE UNIT 515, BALTIMORE, MD 21220-2038
(717) 817-4308
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699030262
NPI TYPE 1
PA
Enumeration date
08/14/2019
Last updated
08/14/2019
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