Provider Demographics
NPI:1801146147
Name:JORDAN, KIMBERLY W (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:W
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PT
Mailing Address - Street 1:7430 SPRING VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4487
Mailing Address - Country:US
Mailing Address - Phone:703-923-4680
Mailing Address - Fax:703-923-4681
Practice Address - Street 1:7430 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4487
Practice Address - Country:US
Practice Address - Phone:703-923-4680
Practice Address - Fax:703-923-4681
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist