Provider Demographics
NPI:1720162217
Name:RIVERA, ROGELIO JR (PT, PHD, DPT, MCHES)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:PT, PHD, DPT, MCHES
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PT, PHD, DPT, MCHES
Mailing Address - Street 1:734 NORTH LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1043
Mailing Address - Country:US
Mailing Address - Phone:713-868-2766
Mailing Address - Fax:713-868-7575
Practice Address - Street 1:734 NORTH LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-1043
Practice Address - Country:US
Practice Address - Phone:713-868-2766
Practice Address - Fax:713-868-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist