Provider Demographics
NPI:1760599773
Name:RIVERA-CARABALLO, FRANCISCO JAVIER (PT)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAVIER
Last Name:RIVERA-CARABALLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:KILA
Mailing Address - State:MT
Mailing Address - Zip Code:59920-0491
Mailing Address - Country:US
Mailing Address - Phone:406-471-8100
Mailing Address - Fax:866-890-6494
Practice Address - Street 1:410 1ST AVE E
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4938
Practice Address - Country:US
Practice Address - Phone:406-471-8100
Practice Address - Fax:866-890-6494
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist