Provider Demographics
NPI:1700683943
Name:JORDAN, GABRIELLA (PT, DPT)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:JORDAN
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 1:16353 119TH LN NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-9402
Mailing Address - Country:US
Mailing Address - Phone:206-418-8942
Mailing Address - Fax:
Practice Address - Street 1:6710 108TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7050
Practice Address - Country:US
Practice Address - Phone:425-979-7445
Practice Address - Fax:425-947-8540
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204302251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic