Healthcare Provider Details

I. General information

NPI: 1255129532
Provider Name (Legal Business Name): JORDYN FROST PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 GALL BLVD
ZEPHYRHILLS FL
33541-4373
US

IV. Provider business mailing address

27948 RAVENS BROOK RD
WESLEY CHAPEL FL
33544-2739
US

V. Phone/Fax

Practice location:
  • Phone: 813-815-9422
  • Fax:
Mailing address:
  • Phone: 813-682-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA32158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: