Healthcare Provider Details

I. General information

NPI: 1528204930
Provider Name (Legal Business Name): FERMIN RIVERA PASCUA PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 W BRISA DR
GILBERT AZ
85233-7306
US

IV. Provider business mailing address

366 W BRISA DR
GILBERT AZ
85233-7306
US

V. Phone/Fax

Practice location:
  • Phone: 480-295-6620
  • Fax:
Mailing address:
  • Phone: 480-295-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6104
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number6104
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: