Provider Demographics
NPI:1902268022
Name:EGGLESTON, JORDAN (PT, DPT, AT)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:PT, DPT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COLEMANS XING
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7115
Mailing Address - Country:US
Mailing Address - Phone:937-578-7841
Mailing Address - Fax:937-578-7891
Practice Address - Street 1:120 COLEMANS XING
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7115
Practice Address - Country:US
Practice Address - Phone:937-578-7841
Practice Address - Fax:937-578-7891
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.015287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist