Provider Demographics
NPI:1225572266
Name:THURMAN, JORDAN (ATC LAT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:THURMAN
Suffix:
Gender:F
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MELVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2050
Mailing Address - Country:US
Mailing Address - Phone:714-349-9845
Mailing Address - Fax:
Practice Address - Street 1:1055 POST RD
Practice Address - Street 2:SELECT PHYSICAL THERAPY
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6019
Practice Address - Country:US
Practice Address - Phone:714-349-9845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer