Individual
MICHAEL JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
835 CRATER LAKE AVE, MEDFORD, OR 97504-6505
(541) 773-7717
Mailing address
835 CRATER LAKE AVE, MEDFORD, OR 97504-6505
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8217
OR
Other
Enumeration date
07/17/2008
Last updated
07/17/2008
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