Provider Demographics
NPI:1962952333
Name:CLAYBORNE, JORDAN (PT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CLAYBORNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N OCEAN DR STE 261
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2956
Mailing Address - Country:US
Mailing Address - Phone:310-405-1945
Mailing Address - Fax:
Practice Address - Street 1:4747 N OCEAN DR STE 261
Practice Address - Street 2:
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-2956
Practice Address - Country:US
Practice Address - Phone:310-405-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 314872251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports