Provider Demographics
NPI:1972048486
Name:JOVEN, MARY LIEZL JAVIER
Entity Type:Individual
Prefix:
First Name:MARY LIEZL
Middle Name:JAVIER
Last Name:JOVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 WHISPERING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-9698
Mailing Address - Country:US
Mailing Address - Phone:540-214-6164
Mailing Address - Fax:
Practice Address - Street 1:2171 WHISPERING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-9698
Practice Address - Country:US
Practice Address - Phone:540-214-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist