Provider Demographics
NPI:1558635169
Name:RIVERA, ANNALIZA GAYE (PT)
Entity Type:Individual
Prefix:
First Name:ANNALIZA GAYE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16089 POPPYSEED CIR
Mailing Address - Street 2:UNIT 2008
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8613 N MILWAUKEE AVE
Practice Address - Street 2:APT 2W
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1965
Practice Address - Country:US
Practice Address - Phone:331-425-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017104225100000X
FLPT 25255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist