Provider Demographics
NPI:1780816850
Name:CUENIN, JORDAN BIRKHEAD (PT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:BIRKHEAD
Last Name:CUENIN
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:NICOLE
Other - Last Name:BIRKHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N MILLS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2183
Mailing Address - Country:US
Mailing Address - Phone:352-804-8822
Mailing Address - Fax:
Practice Address - Street 1:12184 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5012
Practice Address - Country:US
Practice Address - Phone:407-382-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL25972255A2300X
FLPT 26502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer