Provider Demographics
NPI:1881726057
Name:RIVERA, NELIDA (PT)
Entity type:Individual
Prefix:
First Name:NELIDA
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:URB. BELLA VITA
Mailing Address - Street 2:G-77 11A ST.
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-797-2548
Mailing Address - Fax:787-620-9273
Practice Address - Street 1:11A ST. G-77
Practice Address - Street 2:BELLA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6020
Practice Address - Country:US
Practice Address - Phone:787-797-2548
Practice Address - Fax:787-620-9273
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist