| Mr Avery Miles Jordan, LPTA/LPN | |
|
1201 E Broad Rock Rd, Rm 1s-112, Richmond, VA 23249-0001 | |
| (804) 675-5000 | |
| (804) 675-5335 |
| Full Name | Mr Avery Miles Jordan |
|---|---|
| Gender | Male |
| Speciality | Physical Therapy Assistant |
| Location | 1201 E Broad Rock Rd, Richmond, Virginia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639362809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 0002040749 (Virginia) | Secondary |
| 225200000X | Physical Therapy Assistant | 2306001152 (Virginia) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Avery Miles Jordan, LPTA/LPN 3708 Stamford Cir, Midlothian, VA 23112-3671 Ph: (804) 744-5303 | Mr Avery Miles Jordan, LPTA/LPN 1201 E Broad Rock Rd, Rm 1s-112, Richmond, VA 23249-0001 Ph: (804) 675-5000 |