MEDICARE: MARTHA JANETH RIVERA JUNE PT, GCS

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	05004625	IN

General Provider Information

NPI Number	:	1467848499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA JANETH RIVERA JUNE PT, GCS

Provider Business Mailing Address
First Line	:	2060 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1764
Country	:	US
Telephone Number	:	317-635-3499
Fax Number	:	317-635-0449

Provider Business Practice Location Address
First Line	:	2060 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1764
Country	:	US
Telephone Number	:	317-635-3499
Fax Number	:	317-635-0449

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

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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