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NPI Code Detail

MEDICARE: MR. LUIS ALFREDO RIVERA JR. P.T.

MEDICARE: MR. LUIS ALFREDO RIVERA JR. P.T.
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
1225100000XPhysical Therapist070016815IL
22251X0800XOrthopedic Physical Therapist11189-24WI

General Provider Information

NPI Number : 1326119660
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LUIS ALFREDO RIVERA JR. P.T.
Provider Business Mailing Address
First Line : 403 W MEQUON RD
Second Line :
City : MEQUON
State : WI
Zip : 53092-3514
Country : US
Telephone Number : 262-643-4771
Fax Number :
Provider Business Practice Location Address
First Line : 2615 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4245
Country : US
Telephone Number : 414-962-4400
Fax Number : 414-962-5674
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2006
Last Update Date : 12/07/2009

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