Provider Demographics
NPI:1376669853
Name:TUCKER, JORDAN MICHELLE (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHELLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:MICHELLE
Other - Last Name:RITTER-SORONEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:3750 JOSEPH SIEWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1742
Mailing Address - Country:US
Mailing Address - Phone:703-391-1026
Mailing Address - Fax:
Practice Address - Street 1:3750 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1742
Practice Address - Country:US
Practice Address - Phone:703-391-1026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21723225100000X
VA2305205806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist