Provider Demographics
NPI:1316983182
Name:RIVERA, MICHELLE TERESA (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:TERESA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 HIEMENZ RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5220
Mailing Address - Country:US
Mailing Address - Phone:717-392-1567
Mailing Address - Fax:717-392-1567
Practice Address - Street 1:190 N POINTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4132
Practice Address - Country:US
Practice Address - Phone:717-392-8897
Practice Address - Fax:717-392-8898
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007037L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2075646000OtherINDEPENDENCE BLUE CROSS
PA03219401OtherCAPITAL BLUE CROSS
PA1385638OtherHIGHMARK BLUE SHIELD
PA2075646000OtherKEYSTONE HEALTH PLAN EAST
PA213663OtherHEALTHAMERICA/HEALTHASSUR
PA2075646000OtherPERSONAL CHOICE
PA03219401OtherNCAS
PA03219401OtherKEYSTONE HEALTH PLAN CENT
PA1385638OtherPREMIER BLUE PPO
PA7209330OtherAETNA
PA057832QKZMedicare ID - Type UnspecifiedMEDICARE