Provider Demographics
NPI:1427012103
Name:RIVERA, ADA NIVIA (PT)
Entity Type:Individual
Prefix:PROF
First Name:ADA
Middle Name:NIVIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:PROF
Other - First Name:ADA
Other - Middle Name:NIVIA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:ROMANY GARDENS, #9 SANTA ROSA ST.,
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5652
Mailing Address - Country:US
Mailing Address - Phone:787-720-8882
Mailing Address - Fax:787-720-8882
Practice Address - Street 1:1076 CALLE 17
Practice Address - Street 2:VILLA NEVAREZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5326
Practice Address - Country:US
Practice Address - Phone:787-720-8882
Practice Address - Fax:787-720-8882
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist