Provider Demographics
NPI:1891937504
Name:RIVERA, JESSICA (PT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
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 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2362
Mailing Address - Country:US
Mailing Address - Phone:704-603-1403
Mailing Address - Fax:704-603-1517
Practice Address - Street 1:810 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6253
Practice Address - Country:US
Practice Address - Phone:704-216-5633
Practice Address - Fax:704-639-0785
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1352225100000X
NC12072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist