Individual
JORDAN POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
45390 GREEN AVE, CALLAHAN, FL 32011-3711
(904) 879-1223
Mailing address
45390 GREEN AVE, CALLAHAN, FL 32011-3711
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA27386
FL
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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