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Individual

JORDAN PROFITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, ATC/L

Contact information

Practice address
607 DEWEY AVE NW STE 300, GRAND RAPIDS, MI 49504-7335
(253) 332-3398
Mailing address
17927 26TH STREET CT E, LAKE TAPPS, WA 98391-9408
(253) 332-3398

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A160577346
WA

Other

Enumeration date
07/01/2015
Last updated
07/01/2015
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