Jordan Paul Gaston
Individual provider Active NPI Physical Therapist · Thompsons Station, TN
NPI 1760066229 · NPPES record last updated May 11, 2021
Key facts
- NPI
- 1760066229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PTH10120 (AL)
- Practice address
- 1482 Channing Dr
Thompsons Station, TN 37179-2900 - Phone
- (318) 613-0294
- NPI assigned
- May 11, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PTH10120 | AL | Yes |
Addresses
Primary practice location
1482 Channing Dr
Thompsons Station, TN 37179-2900
Mailing address
PO Box 168
Crystal Springs, MS 39059-0168
Phone (850) 588-9641
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTH10120 | Other | AL | ALABAMA PT BOARD |
Other providers in Thompsons Station, TN
- Marguerite Zayas Fetner
- Holly Frey Fields
- First Assistants of Middle Tennessee PLLC
- Matthew Mark Fitterer
- Courtney Foley
- William Benjamin Gray
- Michelle Greaves
- Madison Gumm
- Jessica Nicole Hall
- Breanna Hankins
All providers in Thompsons Station, TN · Physical Therapist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.