Provider Demographics
NPI:1548515778
Name:HILL, JORDAN A (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:HILL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1808
Mailing Address - Country:US
Mailing Address - Phone:207-521-0200
Mailing Address - Fax:207-521-0210
Practice Address - Street 1:4 NORTH ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1808
Practice Address - Country:US
Practice Address - Phone:207-521-0200
Practice Address - Fax:207-521-0210
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist