Provider Demographics
NPI:1023585510
Name:SOUZA, ARESIO (PT, MS, CIE, AEP)
Entity type:Individual
Prefix:MR
First Name:ARESIO
Middle Name:
Last Name:SOUZA
Suffix:
Gender:M
Credentials:PT, MS, CIE, AEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BOORAEM AVE # 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2404
Mailing Address - Country:US
Mailing Address - Phone:917-574-4931
Mailing Address - Fax:
Practice Address - Street 1:112 BOORAEM AVE # 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2404
Practice Address - Country:US
Practice Address - Phone:917-574-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038760-12251H1300X, 2251X0800X, 2251E1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Single Specialty
No2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman FactorsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic