Provider Demographics
NPI:1043081235
Name:RIVERA, JESSICA P (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:P
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:P
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JESSICA PAOLA RIVERA
Mailing Address - Street 1:2903 VALENTINE AVE APT 9C9C9C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2735
Mailing Address - Country:US
Mailing Address - Phone:347-822-9243
Mailing Address - Fax:
Practice Address - Street 1:135 E 50TH ST APT 102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-7517
Practice Address - Country:US
Practice Address - Phone:347-822-9243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist