Most Relevant Information
Provider Data
| NPI Number: | 1003417254 |
| Provider Name: | JORDAN DIMEDIO |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-20-141092 |
Most Important Dates
| Enumeration Date: | 11/04/2020 |
| Last Updated: | 11/04/2020 |
Provider Practice Location
583 SHOEMAKER RD
KING OF PRUSSIA
PA
194064201
Practice Location Phone/Fax
| Phone: | 4846812170 |
| Fax: |
Provider Mailing Location
583 SHOEMAKER RD STE 230
KING OF PRUSSIA
PA
194064238
Provider Mailing Phone/Fax
| Phone: | 4846812170 |
| Fax: |