Provider Demographics
NPI:1245448059
Name:RIVERA, CARLOS JOSE (RPT)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:JOSE
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GRAND BOULEVARD PASEOS
Mailing Address - Street 2:SUITE 112-248
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-632-1555
Mailing Address - Fax:787-283-2776
Practice Address - Street 1:100 GRAND BOULEVARD PASEOS
Practice Address - Street 2:GALERIA PASEOS MALL - SUITE 109
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-283-1554
Practice Address - Fax:787-283-2776
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR929225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87407Medicare ID - Type UnspecifiedPHYSICAL THERAPIST