Healthcare Provider Details

I. General information

NPI: 1265907778
Provider Name (Legal Business Name): JORDAN JUD DPT, PT, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 GULF BREEZE PKWY
GULF BREEZE FL
32561-4838
US

IV. Provider business mailing address

95 WOODRIDGE RD
WESTWOOD MA
02090-3421
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-7306
  • Fax:
Mailing address:
  • Phone: 781-441-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL7356
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: