Provider Demographics
NPI:1083889562
Name:RIVERA, MICHELLE SARA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SARA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 E NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8484
Mailing Address - Country:US
Mailing Address - Phone:386-574-1464
Mailing Address - Fax:386-574-4895
Practice Address - Street 1:1240 E NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8484
Practice Address - Country:US
Practice Address - Phone:386-574-1464
Practice Address - Fax:386-574-4895
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist