Healthcare Provider Details

I. General information

NPI: 1881559227
Provider Name (Legal Business Name): JORDAN MARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 W WOOLBRIGHT RD STE 420
BOYNTON BEACH FL
33437-0917
US

IV. Provider business mailing address

6609 W WOOLBRIGHT RD STE 420
BOYNTON BEACH FL
33437-0917
US

V. Phone/Fax

Practice location:
  • Phone: 561-200-4262
  • Fax: 561-200-4268
Mailing address:
  • Phone: 561-200-4262
  • Fax: 561-200-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA33554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: