Provider Demographics
NPI:1700190048
Name:RIVERA, MARILIAN T (MSPT)
Entity Type:Individual
Prefix:
First Name:MARILIAN
Middle Name:T
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 CALLE REYNA MORA
Mailing Address - Street 2:HACIENDA EL PILAR
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9421
Mailing Address - Country:US
Mailing Address - Phone:787-944-6826
Mailing Address - Fax:
Practice Address - Street 1:2002 CALLE REYNA MORA
Practice Address - Street 2:HACIENDA EL PILAR
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-9421
Practice Address - Country:US
Practice Address - Phone:787-944-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist