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General NPI Number Information
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NPI Number | 1114472743
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Entity Type | Individual
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Provider Name | COURTNEY PAIGE RIVADENEIRA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 7718 WOOD HOLLOW DR STE 105
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City | AUSTIN
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State | TX
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Zip | 78731-1601
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Country | US
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Telephone | 512-795-0053
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Fax |
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Provider Business Mailing Address
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Address Line | 6712 TANAQUA CV
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City | AUSTIN
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State | TX
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Zip | 78739-2023
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1281989
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License Number State | TX
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