Individual
DALLAS JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4138 19TH ST, LUBBOCK, TX 79407-2403
(806) 780-2329
Mailing address
2431 S LOOP 289, LUBBOCK, TX 79423-1519
(806) 771-8008
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1342926
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4204190
MEDICAID
TX
01
—
8PA374
BCBS
TX
Enumeration date
02/11/2021
Last updated
04/01/2021
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