MEDICARE: TARA ANGELA RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA22193	FL

General Provider Information

NPI Number	:	1023825080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA ANGELA RIVERA

Provider Business Mailing Address
First Line	:	1915 RIVER PARK BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4803
Country	:	US
Telephone Number	:	407-694-7042
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 RIVER PARK BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4803
Country	:	US
Telephone Number	:	407-694-7042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2024
Last Update Date	:	12/13/2024

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Directions to “ TARA ANGELA RIVERA ” Practice Location

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