Provider Demographics
NPI:1417971292
Name:RIVERA, FRANK (PT)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 SKYHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5483
Mailing Address - Country:US
Mailing Address - Phone:760-643-9347
Mailing Address - Fax:760-643-1485
Practice Address - Street 1:4980 SKYHAWK WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5483
Practice Address - Country:US
Practice Address - Phone:760-643-9347
Practice Address - Fax:760-643-9347
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 8203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT8203AMedicare ID - Type UnspecifiedMEDICARE PPIN
CAPT8203AMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
CAR62801Medicare UPIN