Provider Demographics
NPI:1265907778
Name:JUD, JORDAN (DPT, PT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:JUD
Suffix:
Gender:F
Credentials:DPT, PT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WOODRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-3421
Mailing Address - Country:US
Mailing Address - Phone:781-441-9634
Mailing Address - Fax:
Practice Address - Street 1:1020 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4838
Practice Address - Country:US
Practice Address - Phone:448-227-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL73562255A2300X
390200000X
FLPT42699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program