Provider Demographics
NPI:1285769992
Name:COTENG, JOSERIZAL RIVERA (PT)
Entity type:Individual
Prefix:MR
First Name:JOSERIZAL
Middle Name:RIVERA
Last Name:COTENG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CHESTNUT STATION CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6395
Mailing Address - Country:US
Mailing Address - Phone:800-335-1060
Mailing Address - Fax:
Practice Address - Street 1:706 NORTH AVE
Practice Address - Street 2:NONE
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3231
Practice Address - Country:US
Practice Address - Phone:269-964-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023970225100000X
WI11116-24225100000X
MI5501016707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41230200Medicaid