MEDICARE: SAMANTHA RIVERON 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

General Provider Information

NPI Number	:	1184261737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RIVERON DPT

Provider Business Mailing Address
First Line	:	7567 CENTRAL PARKE BLVD STE A
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-6855
Country	:	US
Telephone Number	:	513-701-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MAIN ST
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-1605
Country	:	US
Telephone Number	:	513-737-4567
Fax Number	:

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

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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