Provider Demographics
NPI:1245517515
Name:FRANK, JORDAN M (LAT,ATC,CSCS)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:M
Last Name:FRANK
Suffix:
Gender:M
Credentials:LAT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 N WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-2778
Mailing Address - Country:US
Mailing Address - Phone:440-864-0949
Mailing Address - Fax:
Practice Address - Street 1:751 N WOODBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-2778
Practice Address - Country:US
Practice Address - Phone:440-864-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001851A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer