Provider Demographics
NPI:1710466495
Name:RIVERA, GUILE GARZA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GUILE
Middle Name:GARZA
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6126 LOST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2915
Mailing Address - Country:US
Mailing Address - Phone:361-510-0915
Mailing Address - Fax:
Practice Address - Street 1:2033 AIRLINE RD STE E7
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4694
Practice Address - Country:US
Practice Address - Phone:361-500-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1309027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist