Provider Demographics
NPI:1063715829
Name:RIVERA, JOSE R (RPT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:RIVERA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MONTEREY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2537
Mailing Address - Country:US
Mailing Address - Phone:305-441-2320
Mailing Address - Fax:305-441-2470
Practice Address - Street 1:801 MONTEREY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2537
Practice Address - Country:US
Practice Address - Phone:305-441-2320
Practice Address - Fax:305-441-2470
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist