Provider Demographics
NPI:1982820734
Name:RIVERA, VENUS AUSTRIA (PT)
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:AUSTRIA
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 1:291 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1634
Mailing Address - Country:US
Mailing Address - Phone:908-927-0777
Mailing Address - Fax:908-927-0777
Practice Address - Street 1:291 GROVE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1634
Practice Address - Country:US
Practice Address - Phone:908-927-0777
Practice Address - Fax:908-927-0777
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00842600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist