Provider Demographics
NPI:1972147676
Name:PAREDES, JOSE RIVERA JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RIVERA
Last Name:PAREDES
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5612 RUSHMERE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6751
Mailing Address - Country:US
Mailing Address - Phone:757-818-1076
Mailing Address - Fax:
Practice Address - Street 1:5612 RUSHMERE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6751
Practice Address - Country:US
Practice Address - Phone:757-818-1076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist