Jordan Michael Pridgin, DPT
Individual provider Active NPI Physical Therapist · Dover, AR
NPI 1801443767 · NPPES record last updated Aug 23, 2019
Key facts
- NPI
- 1801443767
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT4226 (AR)
- Practice address
- 8952 Market St # 7B
Dover, AR 72837-9110 - Phone
- (479) 331-3303
- NPI assigned
- Aug 23, 2019
- 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)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT4226 | AR | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT4226 | AR | Yes |
Addresses
Primary practice location
8952 Market St # 7B
Dover, AR 72837-9110
Mailing address
1506 W 3Rd St
Russellville, AR 72801-4828
Phone (479) 857-3983
Other providers in Dover, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2019. 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.