MEDICARE: MARQUIS N JORDAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10732	NC
2	225100000X	Physical Therapist	2305204982	VA

General Provider Information

NPI Number	:	1639330590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUIS N JORDAN DPT

Provider Business Mailing Address
First Line	:	9 MADISON CHASE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6115
Country	:	US
Telephone Number	:	910-280-1427
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 MADISON CHASE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-6115
Country	:	US
Telephone Number	:	757-504-4530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	02/10/2026

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