Provider Demographics
NPI:1710251905
Name:RIVERA, JENNIFER M (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10382 BUCK RAKE CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4237
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2590 NORTHBROOKE PLAZA DR
Practice Address - Street 2:107
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8095
Practice Address - Country:US
Practice Address - Phone:239-653-9586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27184225100000X
GAPT010347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist