Individual
JORDAN A EVERETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6920 GATWICK DR STE 120, INDIANAPOLIS, IN 46241-9506
(317) 856-1162
(317) 821-0455
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010910A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201084780
—
IN
Enumeration date
05/24/2012
Last updated
01/08/2015
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