Provider Demographics
NPI:1528374014
Name:RIVERSIDE REHABILITATION LLC
Entity Type:Organization
Organization Name:RIVERSIDE REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOWER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:435-632-3423
Mailing Address - Street 1:2044 MESA PALMS DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5546
Mailing Address - Country:US
Mailing Address - Phone:435-632-3423
Mailing Address - Fax:435-656-2790
Practice Address - Street 1:2044 MESA PALMS DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5546
Practice Address - Country:US
Practice Address - Phone:435-632-3423
Practice Address - Fax:435-656-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty