MEDICARE: CHRISTIAN CAFICI-RIVERA PT, DPT

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	PT016858	GA

General Provider Information

NPI Number	:	1871370445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN CAFICI-RIVERA PT, DPT

Provider Business Mailing Address
First Line	:	2400 WISTERIA DR STE A
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-2689
Country	:	US
Telephone Number	:	770-982-0102
Fax Number	:	770-982-0130

Provider Business Practice Location Address
First Line	:	7378 FRIENDSHIP SPRINGS BLVD STE A
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-5547
Country	:	US
Telephone Number	:	678-318-8030
Fax Number	:	678-318-8031

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

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	09/08/2023

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