Provider Demographics
NPI:1093845885
Name:RIVERA, SANDRA ENID (PT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ENID
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:ENID
Other - Last Name:PAQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 S WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2732
Practice Address - Country:US
Practice Address - Phone:607-756-5637
Practice Address - Fax:607-756-6388
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012903-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist