Healthcare Provider Details

I. General information

NPI: 1720162217
Provider Name (Legal Business Name): ROGELIO RIVERA JR. PT, PHD, DPT, MCHES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROY RIVERA JR. PT, PHD, DPT, MCHES

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 NORTH LOOP
HOUSTON TX
77009-1043
US

IV. Provider business mailing address

734 NORTH LOOP
HOUSTON TX
77009-1043
US

V. Phone/Fax

Practice location:
  • Phone: 713-868-2766
  • Fax: 713-868-7575
Mailing address:
  • Phone: 713-868-2766
  • Fax: 713-868-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1166310
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: