Provider Demographics
NPI:1265630909
Name:RIVERA, NOEMI (LMT)
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7512 N GRADY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2618
Mailing Address - Country:US
Mailing Address - Phone:812-325-8602
Mailing Address - Fax:
Practice Address - Street 1:3115 W COLUMBUS DR
Practice Address - Street 2:SUITE 109
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1865
Practice Address - Country:US
Practice Address - Phone:813-871-1200
Practice Address - Fax:813-871-1204
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26733225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist