Healthcare Provider Details

I. General information

NPI: 1669977294
Provider Name (Legal Business Name): MRS. YVONNE ASANTE KUFFOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 MOUNTAIN LARKSPUR DR
LORTON VA
22079-5728
US

IV. Provider business mailing address

5262 QUEBEC PL
WOODBRIDGE VA
22193-4569
US

V. Phone/Fax

Practice location:
  • Phone: 571-348-4970
  • Fax:
Mailing address:
  • Phone: 301-905-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306603578
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: