Provider Demographics
NPI:1548989445
Name:BATES, JORDAN HENRY (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:HENRY
Last Name:BATES
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 1:39 HOSPITAL CENTER CMNS
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2837
Mailing Address - Country:US
Mailing Address - Phone:843-689-2233
Mailing Address - Fax:843-689-2234
Practice Address - Street 1:39 HOSPITAL CENTER CMNS
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2837
Practice Address - Country:US
Practice Address - Phone:843-689-2233
Practice Address - Fax:843-689-2234
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist