Provider Demographics
NPI:1326602210
Name:RIVERA, ANNETTE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:ANNETTE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120C CALLE MONTEREY PARQUE MONTEREY
Mailing Address - Street 2:APARTMENT 109
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-864-0095
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE PEDRO ALBIZU CAMPUS AVENUE ROAD
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-0095
Practice Address - Fax:787-866-6982
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist