Individual
MR. AVERY MILES JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA/LPN
Contact information
Practice address
1201 E BROAD ROCK RD, RM 1S-112, RICHMOND, VA 23249-0001
(804) 675-5000
(804) 675-5335
Mailing address
3708 STAMFORD CIR, MIDLOTHIAN, VA 23112-3671
(804) 744-5303
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
0002040749
VA
225200000X
Physical Therapy Assistant
Primary
2306001152
VA
Other
Enumeration date
08/21/2007
Last updated
08/21/2007
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