Provider Demographics
NPI:1740403963
Name:RIVERS, JUDEEN VENESSA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDEEN
Middle Name:VENESSA
Last Name:RIVERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RIMINGTON LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2128
Mailing Address - Country:US
Mailing Address - Phone:404-824-6130
Mailing Address - Fax:
Practice Address - Street 1:6600 PEACHTREE DUNWOODY RD # 125
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6773
Practice Address - Country:US
Practice Address - Phone:770-225-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212471225100000X
GA006994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist