MEDICARE: MR. LUIS MANUEL RIVERA JR. MS, LMT

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	225700000X	Massage Therapist	MT-25981	AZ

General Provider Information

NPI Number	:	1396263158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS MANUEL RIVERA JR. MS, LMT

Provider Business Mailing Address
First Line	:	930 N MESA DR UNIT 2036
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4327
Country	:	US
Telephone Number	:	347-966-7533
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 N MESA DR UNIT 2036
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4327
Country	:	US
Telephone Number	:	404-784-1233
Fax Number	:

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

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	03/04/2026

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