Provider Demographics
NPI:1770739534
Name:RIVERS, JUDITH LYNN (PTA)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:LYNN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:LYNN
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5957 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-6204
Mailing Address - Country:US
Mailing Address - Phone:409-982-8878
Mailing Address - Fax:409-982-5119
Practice Address - Street 1:5957 9TH AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6204
Practice Address - Country:US
Practice Address - Phone:409-982-8878
Practice Address - Fax:409-982-5119
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant