Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jordan Louis Fuller, PT, DPT, LAT, ATC

Individual provider Sports Medicine (Physical Medicine & Rehabilitation) Physician · NPI 1992214803

Jordan Louis Fuller, PT, DPT, LAT, ATC is a Physical Therapist in Private Practice in Waltham, Massachusetts. Qualified in 2022, 4 years ago. Practices with Pro Sports Therapy Inc, a 13-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts.

Years since qualifying
4
Licensed in
MA
In the registry since
2017
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.

See every abbreviation used in this directory →

Practice location Address checks out

840 Winter St
Waltham, MA 02451-1433
Phone: (781) 487-9944
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 50 Ocean Ave Apt 513a, Revere, MA 02151-3897 — (916) 337-4524

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 26548 (MA)
Sports Medicine (Physical Medicine & Rehabilitation) Physician Taxonomy 2081S0010X · Licence 3209 (MA)

Record details

NPI number1992214803
Entity typeIndividual (Type 1)
GenderMale
Credentials PT , DPT , LAT , ATC
Sole proprietorNo
NPI enumeratedSeptember 22, 2017
Last updated in NPPESNovember 10, 2022
Certification dateNovember 10, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Pro Sports Therapy Inc — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount