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NPI Code Detail

MEDICARE: TANYA RIVERA PT

MEDICARE:   TANYA  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
1225100000XPhysical Therapist05008041AIN

General Provider Information

NPI Number : 1598912776
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANYA RIVERA PT
Provider Business Mailing Address
First Line : 4102 SHORE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-2608
Country : US
Telephone Number : 317-347-9051
Fax Number :
Provider Business Practice Location Address
First Line : 4102 SHORE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-2608
Country : US
Telephone Number : 317-347-9051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 08/19/2008

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Directions to “ TANYA RIVERA PT” Practice Location

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