Provider Demographics
NPI:1245617315
Name:RIVERA, ELIZA LYNN (PT,DPT,WCS)
Entity Type:Individual
Prefix:MS
First Name:ELIZA
Middle Name:LYNN
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT,DPT,WCS
Other - Prefix:
Other - First Name:ELIZA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4555 EMERSON ST
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4966
Mailing Address - Country:US
Mailing Address - Phone:904-633-0140
Mailing Address - Fax:
Practice Address - Street 1:4555 EMERSON ST
Practice Address - Street 2:SUITE # 220
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4966
Practice Address - Country:US
Practice Address - Phone:904-633-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 231992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID8117ZMedicare PIN