Healthcare Provider Details

I. General information

NPI: 1013566165
Provider Name (Legal Business Name): JORDAN LEE HUFFMAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE 6TH MEDICAL GROUP
MACDILL AFB FL
33621-5023
US

IV. Provider business mailing address

133 41ST AVE NE
SAINT PETERSBURG FL
33703-5823
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9390
  • Fax:
Mailing address:
  • Phone: 712-899-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT33820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: