Provider Demographics
NPI:1235798505
Name:RIVERA, TINA (PTA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A TEAM APPROACH, PT 265 BROAD STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003
Mailing Address - Country:US
Mailing Address - Phone:973-429-3001
Mailing Address - Fax:973-429-2033
Practice Address - Street 1:A TEAM APPROACH, PT 265 BROAD STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003
Practice Address - Country:US
Practice Address - Phone:973-429-3001
Practice Address - Fax:973-429-2033
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00343100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant