Provider Demographics
NPI:1427232255
Name:RIVADENEIRA RIVERA, CARLOS E (LPT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:E
Last Name:RIVADENEIRA RIVERA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0345
Mailing Address - Country:US
Mailing Address - Phone:939-642-6689
Mailing Address - Fax:787-799-6308
Practice Address - Street 1:URB LIRIOS CALA II
Practice Address - Street 2:X404 CALLE SAN MARTIN
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:939-642-6689
Practice Address - Fax:787-799-6308
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR001375OtherPHYSICAL THERAPIST ASIST.