Individual
JORDAN I OUTWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
49 LINDBERGH PL, POUGHKEEPSIE, NY 12603-1335
(845) 380-1812
Mailing address
49 LINDBERGH PL, POUGHKEEPSIE, NY 12603-1335
(845) 380-1812
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/15/2019
Last updated
01/15/2019
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