Basic Information
| Provider Information | |||||||||
| NPI: | 1871141382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLOVER | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | CLAY | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 WISTERIA DR STE A | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300782689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709820102 | ||||||||
| FaxNumber: | 7709820130 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 N DECATUR RD STE 230 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300337430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042947211 | ||||||||
| FaxNumber: | 4042947595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2019 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT014314 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.