Individual
DR. JORDAN BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
529 W SUMMIT AVE STE 1D, CHARLOTTE, NC 28203-4400
(704) 228-3825
Mailing address
529 W SUMMIT AVE STE 1D, CHARLOTTE, NC 28203-4400
(704) 228-3825
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
P18636
NC
208100000X
Physical Medicine & Rehabilitation Physician
PT294526
CA
225100000X
Physical Therapist
PT294526
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT294526
DPT
CA
Enumeration date
02/23/2018
Last updated
12/21/2020
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