Provider Demographics
NPI:1225730880
Name:VALDIVIEZO, VALERIA SUE (DPT)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:SUE
Last Name:VALDIVIEZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KINGSTON TERRACE DR APT A
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9527
Mailing Address - Country:US
Mailing Address - Phone:951-207-8422
Mailing Address - Fax:
Practice Address - Street 1:4152 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4703
Practice Address - Country:US
Practice Address - Phone:609-245-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02112900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist