MEDICARE: JAVIER ANTONIO RIVERA

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	225200000X	Physical Therapy Assistant	2306606837	VA

General Provider Information

NPI Number	:	1790635969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER ANTONIO RIVERA

Provider Business Mailing Address
First Line	:	6110 OZACK CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3983
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4565 DAISY REID AVE
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5670
Country	:	US
Telephone Number	:	703-523-8750
Fax Number	:

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

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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