Provider Demographics
NPI:1669100129
Name:LEONARD, JORDYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:LEONARD
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4720 PUDDLEDOCK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1275
Mailing Address - Country:US
Mailing Address - Phone:804-520-7779
Mailing Address - Fax:
Practice Address - Street 1:4720 PUDDLEDOCK RD STE 130
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1275
Practice Address - Country:US
Practice Address - Phone:804-520-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist