Provider Demographics
NPI:1699561332
Name:RIVERA, REANNA (PTA)
Entity type:Individual
Prefix:
First Name:REANNA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79769 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-4512
Mailing Address - Country:US
Mailing Address - Phone:760-636-8433
Mailing Address - Fax:
Practice Address - Street 1:42150 JACKSON ST STE 103&104
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9780
Practice Address - Country:US
Practice Address - Phone:442-300-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54002225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant