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General NPI Number Information
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NPI Number | 1962306092
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Entity Type | Individual
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Provider Name | GUSTAVO ALEJANDRO RIVERA DAVID DPT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2026
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Last Update Date | 10/03/2026
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Provider Practice Location Address
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Address Line | 2346 MASCOUTAH AVE
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City | BELLEVILLE
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State | IL
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Zip | 62220-3499
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Country | US
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Telephone | 618-277-6282
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2492
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City | COAMO
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State | PR
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Zip | 00769-4492
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Country | US
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Telephone | 787-988-1761
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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 | 070041217
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License Number State | IL
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