=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003793449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYANNA RIVERA PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2025
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6913 JESSICA CT
-----------------------------------------------------
City | NORTH RICHLAND HILLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76182-3667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-422-4416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7809 CREEK MEADOWS DR
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76133-7951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-484-8279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1407179
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------