Provider Demographics
NPI:1730561044
Name:SEDA, JORDAN PERRY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:PERRY
Last Name:SEDA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W 25TH ST RM 601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7480
Mailing Address - Country:US
Mailing Address - Phone:212-255-5531
Mailing Address - Fax:212-255-5377
Practice Address - Street 1:152 W 25TH ST RM 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7480
Practice Address - Country:US
Practice Address - Phone:212-255-5531
Practice Address - Fax:212-255-5377
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039031-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic