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General NPI Number Information
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NPI Number | 1265907778
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Entity Type | Individual
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Provider Name | JORDAN JUD DPT, PT, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 1020 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32561-4838
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Country | US
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Telephone | 448-227-7306
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Fax |
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Provider Business Mailing Address
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Address Line | 95 WOODRIDGE RD
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City | WESTWOOD
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State | MA
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Zip | 02090-3421
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Country | US
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Telephone | 781-441-9634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL7356
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT42699
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License Number State | FL
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