Provider Demographics
NPI:1073776944
Name:RIVERA, FABIOLA ALEJANDRA (PT)
Entity Type:Individual
Prefix:MRS
First Name:FABIOLA
Middle Name:ALEJANDRA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:FABIOLA
Other - Middle Name:ALEJANDRA
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4100 S DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3210
Mailing Address - Country:US
Mailing Address - Phone:405-644-5445
Mailing Address - Fax:405-636-7178
Practice Address - Street 1:4100 SOUTH DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109
Practice Address - Country:US
Practice Address - Phone:405-644-5445
Practice Address - Fax:405-636-7178
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist