Provider Demographics
NPI:1770469025
Name:CARMICHAEL, JORDAN ANDREW (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ANDREW
Last Name:CARMICHAEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHATHAM HEIGHTS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2593
Mailing Address - Country:US
Mailing Address - Phone:540-710-0130
Mailing Address - Fax:
Practice Address - Street 1:12 CHATHAM HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2594
Practice Address - Country:US
Practice Address - Phone:540-710-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305217275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist