Provider Demographics
NPI:1629516752
Name:RIVERA, JOSE E (ATC)
Entity Type:Individual
Prefix:PROF
First Name:JOSE
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ALPINE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3752
Mailing Address - Country:US
Mailing Address - Phone:724-931-0628
Mailing Address - Fax:
Practice Address - Street 1:425 ALPINE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3752
Practice Address - Country:US
Practice Address - Phone:724-931-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001163A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART001163AOtherSTATE LICENSE