Provider Demographics
NPI:1629693106
Name:SUMSION, JORDAN ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ROBERT
Last Name:SUMSION
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 E 400 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1958
Mailing Address - Country:US
Mailing Address - Phone:801-489-5669
Mailing Address - Fax:801-489-5783
Practice Address - Street 1:380 E 400 S
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1958
Practice Address - Country:US
Practice Address - Phone:801-489-5669
Practice Address - Fax:801-489-5783
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8474814-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist