Provider Demographics
NPI:1265817035
Name:HELLUMS, JORDAN PAYNE (PTA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAYNE
Last Name:HELLUMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:PAYNE
Other - Last Name:TARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2431 S LOOP 289
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1519
Mailing Address - Country:US
Mailing Address - Phone:806-771-8008
Mailing Address - Fax:806-771-8009
Practice Address - Street 1:4138 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2403
Practice Address - Country:US
Practice Address - Phone:806-780-2329
Practice Address - Fax:806-780-2330
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPTA2113312TX225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant