Provider Demographics
NPI:1023553476
Name:RIVERA, ANGEL (NYS LMT)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:NYS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4725
Mailing Address - Country:US
Mailing Address - Phone:845-633-3056
Mailing Address - Fax:
Practice Address - Street 1:241 NORTH DR
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4725
Practice Address - Country:US
Practice Address - Phone:845-633-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist