Healthcare Provider Details

I. General information

NPI: 1790635969
Provider Name (Legal Business Name): JAVIER ANTONIO RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 DUNN DR STE 123
STAFFORD VA
22556-1503
US

IV. Provider business mailing address

95 DUNN DR STE 123
STAFFORD VA
22556-1503
US

V. Phone/Fax

Practice location:
  • Phone: 703-523-9565
  • Fax: 833-627-5148
Mailing address:
  • Phone: 703-523-9565
  • Fax: 833-627-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: