Individual
ELLEN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
(601) 683-6644
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3887
MS
Other
Enumeration date
11/06/2007
Last updated
07/18/2012
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