Provider Demographics
NPI:1205052024
Name:RIVERS, MARIA SHIELA (RPT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:SHIELA
Last Name:RIVERS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GREENWOOD LOOP RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1253
Mailing Address - Country:US
Mailing Address - Phone:908-461-2978
Mailing Address - Fax:
Practice Address - Street 1:14 GREENWOOD LOOP RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1253
Practice Address - Country:US
Practice Address - Phone:908-461-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2015-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01054200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist