Provider Demographics
NPI:1659334308
Name:RIVERA PAGAN, NORMA (LPT)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:RIVERA PAGAN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB DOS RIOS
Mailing Address - Street 2:E1 CALLE 9
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-269-3725
Mailing Address - Fax:787-786-4707
Practice Address - Street 1:URB. ROYAL PALM
Practice Address - Street 2:IL25 AVE. NOGAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-269-3725
Practice Address - Fax:787-786-4707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0084156Medicare ID - Type Unspecified