Provider Demographics
NPI:1942071196
Name:RIVERA, ELISA BETH (LMT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:BETH
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:BETH
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:27238 RIO PASS
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4842
Mailing Address - Country:US
Mailing Address - Phone:210-556-9811
Mailing Address - Fax:
Practice Address - Street 1:27238 RIO PASS
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-4842
Practice Address - Country:US
Practice Address - Phone:210-556-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT124225700000X
TXMT124056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist