Healthcare Provider Details

I. General information

NPI: 1134616147
Provider Name (Legal Business Name): JORDAN KFOURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10135 COLVIN RUN RD
GREAT FALLS VA
22066-1872
US

IV. Provider business mailing address

801 W ANN ARBOR TRL STE 220
PLYMOUTH MI
48170-6224
US

V. Phone/Fax

Practice location:
  • Phone: 703-637-8624
  • Fax:
Mailing address:
  • Phone: 866-991-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: