Individual
JORDAN TYLER AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
172 COSTELLO DR, WINCHESTER, VA 22602-4306
(540) 665-4444
Mailing address
192 DOE RUN RD, INWOOD, WV 25428-4128
(304) 590-6173
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
002865
WV
Other
Enumeration date
06/09/2023
Last updated
06/09/2023
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