Provider Demographics
NPI:1679134753
Name:STIELER, JORDAN (PTA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:STIELER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 OXFORD SQ
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3505
Mailing Address - Country:US
Mailing Address - Phone:812-604-3900
Mailing Address - Fax:
Practice Address - Street 1:5311 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9286
Practice Address - Country:US
Practice Address - Phone:812-618-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant