Provider Demographics
NPI:1215596309
Name:NIVAR, THERESA M
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:NIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SW BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8738
Mailing Address - Country:US
Mailing Address - Phone:848-224-9181
Mailing Address - Fax:
Practice Address - Street 1:535 SW BUTLER AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8738
Practice Address - Country:US
Practice Address - Phone:848-224-9181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist