MEDICARE: MS. ELISSA RIVA WEISER BA, PTA

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	174400000X	Specialist	PTA22569	FL

General Provider Information

NPI Number	:	1588954168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISSA RIVA WEISER BA, PTA

Provider Business Mailing Address
First Line	:	1164 NORMANDY DRIVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141
Country	:	US
Telephone Number	:	786-624-8693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 NORMANDY DR
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2812
Country	:	US
Telephone Number	:	305-868-9905
Fax Number	:

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

Provider Enumeration Date	:	04/15/2011
Last Update Date	:	04/15/2011

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