Provider Demographics
NPI:1649669227
Name:NIHOUL, JORDAN MARKS (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARKS
Last Name:NIHOUL
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 NEW PARK AVE BLDG 4B
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1329
Mailing Address - Country:US
Mailing Address - Phone:475-316-1786
Mailing Address - Fax:
Practice Address - Street 1:635 NEW PARK AVE BLDG 4B
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1329
Practice Address - Country:US
Practice Address - Phone:475-316-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist