Provider Demographics
NPI:1336181023
Name:RIVERA, LOUIS RAYMOND (PT)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:RAYMOND
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 HIEMENZ RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5220
Mailing Address - Country:US
Mailing Address - Phone:717-392-1567
Mailing Address - Fax:717-392-1567
Practice Address - Street 1:190 N POINTE BLVD
Practice Address - Street 2:SUITE TWO
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-392-8897
Practice Address - Fax:717-392-8898
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002137E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01887702OtherCAPITAL BLUE CROSS
PA01887702OtherKEYSTONE HEALTH PLAN CENT
PA01887702OtherNCAS
PA209598OtherHEALTHAMERICA/HEALTHASSUR
PA517039OtherHIGHMARK BLUE SHIELD
PA5401044OtherAETNA
PA209598OtherHEALTHAMERICA/HEALTHASSUR