Individual
JORDAN PAUL GASTON
Active
Individual
JORDAN PAUL GASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH10120
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTH10120
ALABAMA PT BOARD
AL
Enumeration date
05/11/2021
Last updated
05/11/2021
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