Healthcare Provider Details

I. General information

NPI: 1386578367
Provider Name (Legal Business Name): JESSICA YUUKI ANDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9447 LORTON MARKET ST UNIT 250
LORTON VA
22079-1963
US

IV. Provider business mailing address

6038 LINCOLNIA RD
ALEXANDRIA VA
22312-2736
US

V. Phone/Fax

Practice location:
  • Phone: 703-372-5716
  • Fax:
Mailing address:
  • Phone: 678-447-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217745
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: