Individual
MR. JORDAN BROOK MOCKTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACSM-EP
Contact information
Practice address
1500 E CEDAR AVE STE 52, FLAGSTAFF, AZ 86004-1643
(928) 773-1245
(928) 773-9429
Mailing address
5404 E. CORTLAND BLVD 190, FLAGSTAFF, AZ 86004
(928) 255-7867
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
1059346
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D04316506
—
AZ
Enumeration date
04/06/2022
Last updated
04/11/2022
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