Individual
JORDAN STODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
804 PANCHERI DR, IDAHO FALLS, ID 83402-3344
(208) 403-7422
Mailing address
3716 E 343 N, RIGBY, ID 83442-5326
(208) 403-7422
Taxonomy
Speciality
Code
Description
License number
State
2251C2600X
Cardiopulmonary Physical Therapist
—
—
2251G0304X
Geriatric Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
Primary
PT-3572
ID
Other
Enumeration date
11/11/2020
Last updated
12/03/2020
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