Provider Demographics
NPI:1912637158
Name:RIVERA, SAMUEL ADOLFO
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ADOLFO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 SW 195TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6211
Mailing Address - Country:US
Mailing Address - Phone:954-734-0817
Mailing Address - Fax:
Practice Address - Street 1:4507 SW 195TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-6211
Practice Address - Country:US
Practice Address - Phone:954-734-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist