Provider Demographics
NPI:1992001440
Name:RIVERA, AGNES (PT)
Entity Type:Individual
Prefix:
First Name:AGNES
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 1:501 S AUSTIN AVE
Mailing Address - Street 2:#1310
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5637
Mailing Address - Country:US
Mailing Address - Phone:512-864-6050
Mailing Address - Fax:512-869-8157
Practice Address - Street 1:501 S AUSTIN AVE
Practice Address - Street 2:#1310
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5637
Practice Address - Country:US
Practice Address - Phone:512-864-6050
Practice Address - Fax:512-869-8157
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist