Provider Demographics
NPI:1871920900
Name:BLATT, JORDAN (DPT)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:BLATT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:BARAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:120 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:610-270-0370
Mailing Address - Fax:610-270-0374
Practice Address - Street 1:1608 WALNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5457
Practice Address - Country:US
Practice Address - Phone:215-545-8717
Practice Address - Fax:215-545-9355
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0231332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic