Provider Demographics
NPI:1790102465
Name:RIVERS, HENRY (ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:RIVERS
Suffix:
Gender:M
Credentials:ATC,CSCS
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 1470
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702-1470
Mailing Address - Country:US
Mailing Address - Phone:229-483-6300
Mailing Address - Fax:229-431-3309
Practice Address - Street 1:601 N. VAN BRUEN ST.
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31702
Practice Address - Country:US
Practice Address - Phone:229-483-6300
Practice Address - Fax:229-431-3309
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer