Healthcare Provider Details

I. General information

NPI: 1194653592
Provider Name (Legal Business Name): JORDYN HIGHTOWER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AVI SHEPHARD LMT

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S PARK SQ # 115
FRUITA CO
81521-2531
US

IV. Provider business mailing address

460 CEDAR GLEN WAY
FRUITA CO
81521-3156
US

V. Phone/Fax

Practice location:
  • Phone: 970-508-9816
  • Fax:
Mailing address:
  • Phone: 970-508-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0027197
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: