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General NPI Number Information
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NPI Number | 1558635169
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Entity Type | Individual
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Provider Name | ANNALIZA GAYE RIVERA PT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 8613 N MILWAUKEE AVE APT 2W
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City | NILES
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State | IL
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Zip | 60714-1965
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Country | US
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Telephone | 331-425-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 16089 POPPYSEED CIR UNIT 2008
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6314
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.017104
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 25255
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License Number State | FL
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