Provider Demographics
NPI:1437515350
Name:RIVERA, JULIAN JOSEPH (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:JOSEPH
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S HOWARD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2412
Mailing Address - Country:US
Mailing Address - Phone:813-258-2918
Mailing Address - Fax:813-258-2930
Practice Address - Street 1:609 S HOWARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2412
Practice Address - Country:US
Practice Address - Phone:813-258-2918
Practice Address - Fax:813-258-2930
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039458225100000X
FLPT31125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist