MEDICARE: PROF. ADA NIVIA RIVERA PT

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	225100000X	Physical Therapist	337	PR

General Provider Information

NPI Number	:	1427012103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ADA NIVIA RIVERA PT

Provider Business Mailing Address
First Line	:	ROMANY GARDENS, #9 SANTA ROSA ST.,
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-5652
Country	:	US
Telephone Number	:	787-720-8882
Fax Number	:	787-720-8882

Provider Business Practice Location Address
First Line	:	1076 CALLE 17
Second Line	:	VILLA NEVAREZ
City	:	SAN JUAN
State	:	PR
Zip	:	00927-5326
Country	:	US
Telephone Number	:	787-720-8882
Fax Number	:	787-720-8882

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	10/28/2010

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