Provider Demographics
NPI:1518351576
Name:RIVAS, JOSE-LUIS JR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSE-LUIS
Middle Name:
Last Name:RIVAS
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 N EMERALD DR
Mailing Address - Street 2:APARTMENT E31
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:365 N EMERALD DR
Practice Address - Street 2:APARTMENT E31
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6153
Practice Address - Country:US
Practice Address - Phone:760-705-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist