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General NPI Number Information
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NPI Number | 1699112078
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Entity Type | Individual
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Provider Name | REBECCA MARIE RIVERA LMT
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Gender | Female
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Dates
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Enumeration Date | 05/26/2013
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Last Update Date | 05/24/2014
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Provider Practice Location Address
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Address Line | 900 ERIE BLVD W
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City | ROME
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State | NY
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Zip | 13440-2904
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Country | US
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Telephone | 315-339-3124
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Fax |
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Provider Business Mailing Address
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Address Line | 1208 JERVIS AVE
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City | ROME
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State | NY
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Zip | 13440-2343
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Country | US
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Telephone | 315-334-9217
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Fax | 315-334-9217
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 013581
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License Number State | NY
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