MEDICARE: DR. ADIA ELIZABETH RIVERS 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	2305204428	VA

General Provider Information

NPI Number	:	1285967414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADIA ELIZABETH RIVERS DPT

Provider Business Mailing Address
First Line	:	2720 CHESTERFIELD BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-4533
Country	:	US
Telephone Number	:	757-513-7990
Fax Number	:	757-233-9838

Provider Business Practice Location Address
First Line	:	2720 CHESTERFIELD BLVD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-4533
Country	:	US
Telephone Number	:	757-513-7990
Fax Number	:	757-233-9838

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

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/04/2009

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