Active NPI
Jennifer Jordan Lander, P. T.
- Pediatric Physical Therapist
- Pembroke, GA
National Provider Identifier
1649225624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- Practice address
- 163 Winding Way
Pembroke, GA 31321-5535 - Phone
- (912) 547-0181
- Fax
- (912) 653-7979
- NPI assigned
- May 24, 2006
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | Primary | ||
| Neurology Physical Therapist | 2251N0400X | 4288 | GA | |
| Physical Therapist | 225100000X | 4288 | GA |
Addresses
Primary practice location
163 Winding Way
Pembroke, GA 31321-5535
Mailing address
PO Box 39
Pembroke, GA 31321-0039
Phone (912) 653-4863
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000859075A | Medicaid | GA |
Other names 1
- Jennifer Lee Jordan
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 |
|---|---|---|---|
| 4288 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266969600000",
"number": "1649225624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 39",
"city": "PEMBROKE",
"state": "GA",
"postal_code": "313210039",
"telephone_number": "912-653-4863",
"fax_number": "912-653-7979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "163 WINDING WAY",
"city": "PEMBROKE",
"state": "GA",
"postal_code": "313215535",
"telephone_number": "912-547-0181",
"fax_number": "912-653-7979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDER",
"first_name": "JENNIFER",
"middle_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "P. T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-05-24",
"last_updated": "2010-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": null,
"license": null,
"primary": true
},
{
"code": "2251N0400X",
"taxonomy_group": "",
"desc": "Physical Therapist, Neurology",
"state": "GA",
"license": "4288",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "4288",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000859075A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "JORDAN",
"middle_name": "LEE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Pembroke, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.