Provider Demographics
NPI:1255025086
Name:RIORDAN, JAZMIN BREANA
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:BREANA
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 MEMORIAL DR STE 403
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8218
Mailing Address - Country:US
Mailing Address - Phone:614-602-2264
Mailing Address - Fax:
Practice Address - Street 1:6065 MEMORIAL DR STE 403
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-8218
Practice Address - Country:US
Practice Address - Phone:614-602-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist