Provider Demographics
NPI:1629004783
Name:RIVERA-ORTIZ, SEVERO (PT)
Entity Type:Individual
Prefix:
First Name:SEVERO
Middle Name:
Last Name:RIVERA-ORTIZ
Suffix:
Gender:M
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:URB.VILLA BORINQUEN,
Mailing Address - Street 2:I 13 GUANINA ST
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-258-4279
Mailing Address - Fax:
Practice Address - Street 1:I13 CALLE GUANINA
Practice Address - Street 2:URB. VILLA BORINQUEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-8007
Practice Address - Country:US
Practice Address - Phone:787-258-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR362OtherPR LICENCE