Provider Demographics
NPI:1285743864
Name:RIVERA, JANET (PT, BA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 SE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-2208
Mailing Address - Country:US
Mailing Address - Phone:954-599-4642
Mailing Address - Fax:
Practice Address - Street 1:1990 S CANAL DR
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1046
Practice Address - Country:US
Practice Address - Phone:305-246-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1244225100000X
FL23076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist