Provider Demographics
NPI:1093105603
Name:RIVERA, GABRIELLA (PT)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2514
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:2960 E NEES AVE
Practice Address - Street 2:STE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-6012
Practice Address - Country:US
Practice Address - Phone:559-322-4103
Practice Address - Fax:559-322-4104
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 42164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist