MEDICARE: MICHAEL RIVAS GARAYGAY PT

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	070-008459	IL
2	225100000X	Physical Therapist	2008037338	MO

General Provider Information

NPI Number	:	1962644765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RIVAS GARAYGAY PT

Provider Business Mailing Address
First Line	:	711 STONEWOOD BEND DR
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-4064
Country	:	US
Telephone Number	:	636-265-2562
Fax Number	:	636-561-0966

Provider Business Practice Location Address
First Line	:	711 STONEWOOD BEND DR
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-4064
Country	:	US
Telephone Number	:	636-265-3185
Fax Number	:

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	07/23/2025

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