Provider Demographics
NPI:1871139907
Name:RINE, JORDYN ASHLYN (MS, ATC, CES)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:ASHLYN
Last Name:RINE
Suffix:
Gender:F
Credentials:MS, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 GEORGETOWN RD APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2435
Mailing Address - Country:US
Mailing Address - Phone:619-481-8153
Mailing Address - Fax:
Practice Address - Street 1:111 MONTICELLO AVE STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5698
Practice Address - Country:US
Practice Address - Phone:434-817-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260031882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer