Provider Demographics
NPI:1760158810
Name:JAVIER, JOHN MICHAEL
Entity Type:Individual
Prefix:
First Name:JOHN MICHAEL
Middle Name:
Last Name:JAVIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 QUAKER ST # 1
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-1028
Mailing Address - Country:US
Mailing Address - Phone:646-923-6768
Mailing Address - Fax:
Practice Address - Street 1:11 QUAKER ST # 1
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1028
Practice Address - Country:US
Practice Address - Phone:646-923-6768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist