Healthcare Provider Details

I. General information

NPI: 1245448059
Provider Name (Legal Business Name): CARLOS JOSE RIVERA RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND BOULEVARD PASEOS GALERIA PASEOS MALL - SUITE 109
SAN JUAN PR
00926
US

IV. Provider business mailing address

100 GRAND BOULEVARD PASEOS SUITE 112-248
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-283-1554
  • Fax: 787-283-2776
Mailing address:
  • Phone: 787-632-1555
  • Fax: 787-283-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number929
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number929
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: