Provider Demographics
NPI:1073644266
Name:RIVERA, SIDNEY W II (DPT)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:W
Last Name:RIVERA
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 GALAXIE AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8602
Mailing Address - Country:US
Mailing Address - Phone:651-241-3880
Mailing Address - Fax:651-341-3890
Practice Address - Street 1:14655 GALAXIE AVE STE 160
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8602
Practice Address - Country:US
Practice Address - Phone:651-241-3880
Practice Address - Fax:651-341-3890
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist