Provider Demographics
NPI:1558581850
Name:CORREA RIVERA, SONIA M (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:M
Last Name:CORREA RIVERA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 SYCAMORE PL
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1075
Mailing Address - Country:US
Mailing Address - Phone:787-617-6671
Mailing Address - Fax:
Practice Address - Street 1:1442 SYCAMORE PL
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1075
Practice Address - Country:US
Practice Address - Phone:787-617-6671
Practice Address - Fax:787-797-4128
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LA09991R225100000X
PR1346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist