Provider Demographics
NPI:1447026091
Name:AGEE, JORDAN (LMT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:AGEE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 N DESERT AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2027
Mailing Address - Country:US
Mailing Address - Phone:509-953-1960
Mailing Address - Fax:
Practice Address - Street 1:953 N DESERT AVE UNIT C
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2027
Practice Address - Country:US
Practice Address - Phone:509-953-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-29459225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist