Individual
PHYLLIS V JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, RMP
Contact information
Practice address
263 W PATRICK ST, FREDERICK, MD 21701-6910
(301) 388-5237
Mailing address
21 E A ST APT 1, BRUNSWICK, MD 21716-1473
(240) 578-5958
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
0019015415
VA
225700000X
Massage Therapist
Primary
R02519
MD
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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