Active NPI
Jordan Theroux
- Physician Assistant
- Manchester, CT
National Provider Identifier
1679403273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 71 Haynes St
Manchester, CT 06040-4131 - Phone
- (860) 646-1222
- NPI assigned
- May 23, 2026
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
71 Haynes St
Manchester, CT 06040-4131
Mailing address
9 Rachel Ann CT
Prospect, CT 06712-1570
Other practice location 1
435 Lewis Ave
Meriden, CT 06451-2101
Phone (203) 694-8200
Other practice location 2
81 Meriden Ave
Southington, CT 06489-3268
Phone (860) 276-5000
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1779494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779494400000",
"number": "1679403273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 RACHEL ANN CT",
"city": "PROSPECT",
"state": "CT",
"postal_code": "067121570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404131",
"telephone_number": "860-646-1222"
}
],
"practiceLocations": [
{
"address_1": "435 Lewis Ave",
"address_purpose": "LOCATION",
"city": "Meriden",
"state": "CT",
"postal_code": "064512101",
"country_code": "US",
"telephone_number": "203-694-8200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "81 Meriden Ave",
"address_purpose": "LOCATION",
"city": "Southington",
"state": "CT",
"postal_code": "064893268",
"country_code": "US",
"telephone_number": "860-276-5000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THEROUX",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-05-23",
"last_updated": "2026-05-23",
"certification_date": "2026-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.