Active NPI
Susan P Jordan, PTA
- Physical Therapy Assistant
- Denton, MD
National Provider Identifier
1497090369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A3417
- Practice address
- 520 Kerr Ave
Denton, MD 21629-1343 - Phone
- (410) 479-2130
- Fax
- (410) 479-3057
- NPI assigned
- Dec 4, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A3417 | MD | Primary |
Addresses
Primary practice location
520 Kerr Ave
Denton, MD 21629-1343
Mailing address
200 Northpointe Circle Suite 302
Seven Fields, PA 16046
Phone (410) 479-2130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A3417 | MD | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354579200000",
"number": "1497090369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 NORTHPOINTE CIRCLE SUITE 302",
"city": "SEVEN FIELDS",
"state": "PA",
"postal_code": "16046",
"telephone_number": "410-479-2130",
"fax_number": "410-479-3057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 KERR AVE",
"city": "DENTON",
"state": "MD",
"postal_code": "216291343",
"telephone_number": "410-479-2130",
"fax_number": "410-479-3057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "SUSAN",
"middle_name": "P",
"name_prefix": "Ms.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-04",
"last_updated": "2012-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MD",
"license": "A3417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Denton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.