Provider Demographics
NPI:1295844843
Name:RIVAS, LORI (MSPT, COMT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MSPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13224 SW 212TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7499
Mailing Address - Country:US
Mailing Address - Phone:786-218-3692
Mailing Address - Fax:
Practice Address - Street 1:13224 SW 212TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-7499
Practice Address - Country:US
Practice Address - Phone:786-218-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT21218OtherLICENSE #