Provider Demographics
NPI:1376744730
Name:JUMP, JOHN (CPO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:JUMP
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PRIMERA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2127
Mailing Address - Country:US
Mailing Address - Phone:407-232-9944
Mailing Address - Fax:407-232-9966
Practice Address - Street 1:725 PRIMERA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2127
Practice Address - Country:US
Practice Address - Phone:407-232-9944
Practice Address - Fax:407-232-9966
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-08-17
Deactivation Date:2010-09-21
Deactivation Code:
Reactivation Date:2013-01-10
Provider Licenses
StateLicense IDTaxonomies
FLPOR142222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist