Healthcare Provider Details

I. General information

NPI: 1992889430
Provider Name (Legal Business Name): DANIELLE RIVERA M.S.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9180 FOREST HILL BLVD
WELLINGTON FL
33411-6564
US

IV. Provider business mailing address

17281 ORANGE GROVE BLVD
LOXAHATCHEE FL
33470-3551
US

V. Phone/Fax

Practice location:
  • Phone: 561-333-5351
  • Fax: 561-333-5374
Mailing address:
  • Phone: 561-598-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: