MEDICARE: REBECCA LYNN RIVERA PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	28212	MA

General Provider Information

NPI Number	:	1083429443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LYNN RIVERA PT, DPT

Provider Business Mailing Address
First Line	:	4 RICHMOND SQ
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02906-5117
Country	:	US
Telephone Number	:	401-433-4172
Fax Number	:	401-433-0612

Provider Business Practice Location Address
First Line	:	63 MELCHER ST STE 100
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-1534
Country	:	US
Telephone Number	:	857-250-4597
Fax Number	:	857-305-0482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	10/15/2025

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