Healthcare Provider Details

I. General information

NPI: 1396854949
Provider Name (Legal Business Name): JOSE RIVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20241 SW 127TH AVE
MIAMI FL
33177-5119
US

IV. Provider business mailing address

13224 SW 212TH ST
MIAMI FL
33177-7499
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-1617
  • Fax:
Mailing address:
  • Phone: 305-331-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT21219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: