Provider Demographics
NPI:1063642692
Name:JORGE, JOSE MARTIN (RRT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MARTIN
Last Name:JORGE
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:MR
Other - First Name:MARTIN
Other - Middle Name:
Other - Last Name:JORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:137 POINTER LN
Mailing Address - Street 2:
Mailing Address - City:GORDONSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22942-6864
Mailing Address - Country:US
Mailing Address - Phone:434-984-2547
Mailing Address - Fax:
Practice Address - Street 1:137 POINTER LN
Practice Address - Street 2:
Practice Address - City:GORDONSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22942-6864
Practice Address - Country:US
Practice Address - Phone:434-984-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01170035972279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care