Active NPI
Jordan Jenkins
- Physical Therapy Assistant
- South Daytona, FL
National Provider Identifier
1669625273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2033132
- Practice address
- 917 Beville Rd
Suite G
South Daytona, FL 32119-1712 - Phone
- (386) 756-4395
- Fax
- (866) 426-2811
- NPI assigned
- Oct 28, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2033132 | TX | Primary |
Addresses
Primary practice location
917 Beville Rd
Suite G
South Daytona, FL 32119-1712
Mailing address
2801 Richmond Rd
#315
Texarkana, TX 75503-2123
Phone (903) 278-7867
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2033132 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1669625273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 RICHMOND RD",
"address_2": "#315",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755032123",
"telephone_number": "903-278-7867",
"fax_number": "866-426-1396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 BEVILLE RD",
"address_2": "SUITE G",
"city": "SOUTH DAYTONA",
"state": "FL",
"postal_code": "321191712",
"telephone_number": "386-756-4395",
"fax_number": "866-426-2811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2033132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Daytona, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.