Healthcare Provider Details

I. General information

NPI: 1881902013
Provider Name (Legal Business Name): JOSHUA KARL RIVERA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 ARAMINGO AVE
PHILADELPHIA PA
19134-4500
US

IV. Provider business mailing address

1495 SYCAMORE AVE
WILLOW GROVE PA
19090-1019
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-2242
  • Fax: 215-427-2433
Mailing address:
  • Phone: 267-315-0934
  • Fax: 215-427-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003607
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: