Provider Demographics
NPI:1851993083
Name:BOYD, JORDAN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9757 PINE LAKE DR APT 3089
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6165
Mailing Address - Country:US
Mailing Address - Phone:615-243-5110
Mailing Address - Fax:
Practice Address - Street 1:12573 BROADWAY ST STE 151
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8973
Practice Address - Country:US
Practice Address - Phone:713-868-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist