Jordan T Park

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA31577 Issued in FL

Practice address

3401 W Gore Blvd
Lawton, OK 73505-6332

Phone

(580) 355-8620

NPI assigned

Feb 20, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1295433191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 NW SHERIDAN RD APT 1705",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-355-8620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1680 Eatonton Rd",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "GA",
            "postal_code": "306504628",
            "country_code": "US",
            "telephone_number": "706-342-1971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "JORDAN",
        "middle_name": "T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004927",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA31577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Twyla Palmer, RN
• Misty Panter, RN
• Emann Parent
• Vrajesh M Parikh, MD
• Park Ridge Physical Therapy, P.C.
• SE Hun Park, ATC
• Parker Place Home 1, LLC.
• Parker Place Home 2, LLC.
• Alexandra Parker
• Rebecca Ann Parker

• Physical Therapy Assistant in Lawton, OK
• Providers in Lawton, OK by specialty
• Physical Therapy Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.