Provider Demographics
NPI:1093850141
Name:RIVERA GUEVAREZ, WANDA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:
Last Name:RIVERA GUEVAREZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:EDIF. LAS VEGAS #420, BO. CAMPO ALEGRE
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1086
Mailing Address - Country:US
Mailing Address - Phone:787-854-1426
Mailing Address - Fax:787-884-3757
Practice Address - Street 1:EDIF. LAS VEGAS #420, BO. CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1086
Practice Address - Country:US
Practice Address - Phone:787-854-1426
Practice Address - Fax:787-884-3757
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist