Provider Demographics
NPI:1114647112
Name:PALMA, JORDAN ESTUARDO (DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ESTUARDO
Last Name:PALMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-2613
Mailing Address - Country:US
Mailing Address - Phone:941-485-1505
Mailing Address - Fax:941-485-7495
Practice Address - Street 1:3030 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-2613
Practice Address - Country:US
Practice Address - Phone:941-485-1505
Practice Address - Fax:941-485-7495
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18617225100000X
FLPT42427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist