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General NPI Number Information
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NPI Number | 1942181326
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Entity Type | Individual
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Provider Name | GENESIS RIVERA SIMON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 3016 LONGTOWN COMMONS DR STE 200A&305
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City | COLUMBIA
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State | SC
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Zip | 29229-7861
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Country | US
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Telephone | 803-314-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 ASHLYNN WAY
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City | SUMTER
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State | SC
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Zip | 29154-8280
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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 | 11597
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License Number State | SC
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