Provider Demographics
NPI:1558960773
Name:RIVERA, JOSHUA (PTA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27120 E FREMONT PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-6219
Mailing Address - Country:US
Mailing Address - Phone:720-483-6936
Mailing Address - Fax:
Practice Address - Street 1:4380 S SYRACUSE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2607
Practice Address - Country:US
Practice Address - Phone:303-488-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013665225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant