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General NPI Number Information
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NPI Number | 1790635969
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Entity Type | Individual
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Provider Name | JAVIER ANTONIO RIVERA
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Gender | Male
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 4565 DAISY REID AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5670
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Country | US
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Telephone | 703-523-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 6110 OZACK CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-3983
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306606837
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License Number State | VA
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