Provider Demographics
NPI:1275879033
Name:RIVERA, KATHERINE (PT)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CALLE PAZ
Mailing Address - Street 2:PARAISO DE COAMO
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9324
Mailing Address - Country:US
Mailing Address - Phone:787-210-8752
Mailing Address - Fax:
Practice Address - Street 1:625 CALLE PAZ
Practice Address - Street 2:PARAISO DE COAMO
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9324
Practice Address - Country:US
Practice Address - Phone:787-210-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist