Provider Demographics
NPI:1558811851
Name:BODY ARMOR SPORTS AND ORTHOPEDIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BODY ARMOR SPORTS AND ORTHOPEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:CLAYBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-405-1945
Mailing Address - Street 1:7928 EAST DR APT 2001
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5685
Mailing Address - Country:US
Mailing Address - Phone:310-405-1945
Mailing Address - Fax:
Practice Address - Street 1:7928 EAST DR APT 2001
Practice Address - Street 2:
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-5685
Practice Address - Country:US
Practice Address - Phone:310-405-1945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 31487261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy