Provider Demographics
NPI:1225842313
Name:NIEVES, ALEX (PTA)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:NIEVES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CENTRAL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2545
Mailing Address - Country:US
Mailing Address - Phone:908-654-4252
Mailing Address - Fax:
Practice Address - Street 1:525 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2545
Practice Address - Country:US
Practice Address - Phone:908-654-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00416700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant