Provider Demographics
NPI:1134682982
Name:SEXTON, JORDAN N (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:SEXTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16627 FISHHAWK BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4369
Mailing Address - Country:US
Mailing Address - Phone:813-737-8550
Mailing Address - Fax:808-591-2245
Practice Address - Street 1:16627 FISHHAWK BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4369
Practice Address - Country:US
Practice Address - Phone:813-737-8550
Practice Address - Fax:808-591-2245
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-4789225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3213OtherUNIVERSITY HEALTH ALLIANCE