Provider Demographics
NPI:1245504257
Name:RIVERA, ANNETTE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
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 1:516 NEPTUNO STREET
Mailing Address - Street 2:URB VISTAS DE MONTE SOL
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:516 CALLE NEPTUNO
Practice Address - Street 2:URB VISTAS DE MONTE SOL
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4183
Practice Address - Country:US
Practice Address - Phone:787-615-0015
Practice Address - Fax:787-840-0490
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist