Individual
FREDA MAE DIASANTA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
1900 10TH ST, SILVIS, IL 61282-1909
(309) 278-1537
Mailing address
10500 WAYZATA BLVD, HOPKINS, MN 55305-1511
(952) 224-1919
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
032857
NY
225100000X
Physical Therapist
Primary
070018721
IL
Other
Enumeration date
10/17/2011
Last updated
12/05/2014
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