Individual
JORDAN CONGLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
7774 DAYTON SPRINGFIELD RD, FAIRBORN, OH 45324-1957
(937) 340-6261
Mailing address
PO BOX 3, SOUTH VIENNA, OH 45369-0003
(937) 561-1941
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
52592
CA
Other
Enumeration date
06/05/2023
Last updated
06/05/2023
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