Provider Demographics
NPI:1821229212
Name:RIVERA-ALICEA, GLYSELL (PT, DPT COMT)
Entity Type:Individual
Prefix:
First Name:GLYSELL
Middle Name:
Last Name:RIVERA-ALICEA
Suffix:
Gender:F
Credentials:PT, DPT COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24014 W RENWICK RD UNIT 206
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 W FRONTAGE RD STE 3800
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1242
Practice Address - Country:US
Practice Address - Phone:800-974-4378
Practice Address - Fax:630-515-1536
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37444225100000X
KS11-06848225100000X
WI15714-24225100000X
ALPTH10376225100000X
PAPT029565225100000X
MI5501020266225100000X
SD2390225100000X
OHPT019659225100000X
PR4611225100000X
IL070.017228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist