MEDICARE: MICHELE ARLENE RIVERA-ACOSTA

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	225200000X	Physical Therapy Assistant	PTA 21311	FL

General Provider Information

NPI Number	:	1881859262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE ARLENE RIVERA-ACOSTA

Provider Business Mailing Address
First Line	:	3007 HEMINGWAY CIR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-2856
Country	:	US
Telephone Number	:	863-899-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	35902 HWY 27
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-3737
Country	:	US
Telephone Number	:	863-421-1777
Fax Number	:

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

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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