Provider Demographics
NPI:1174164727
Name:MARTINEZ, JORDAN HIGHTOWER
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:HIGHTOWER
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-5014
Mailing Address - Country:US
Mailing Address - Phone:806-787-0678
Mailing Address - Fax:
Practice Address - Street 1:406 TERRACE CIR
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-5014
Practice Address - Country:US
Practice Address - Phone:806-787-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT86342255A2300X
TX2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer