Provider Demographics
NPI:1538405352
Name:SHOCKEY, JOURDAN KALLI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOURDAN
Middle Name:KALLI
Last Name:SHOCKEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 MARKVILLE DR
Mailing Address - Street 2:#415
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3590
Mailing Address - Country:US
Mailing Address - Phone:214-793-2647
Mailing Address - Fax:
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 4000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-820-1884
Practice Address - Fax:214-820-1654
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist