MEDICARE: STEPHEN DAVID RIVOIRE MS,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	5187	CO
2	2251N0400X	Neurology Physical Therapist	5187	CO
3	2251X0800X	Orthopedic Physical Therapist	5187	CO

General Provider Information

NPI Number	:	1972571164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN DAVID RIVOIRE MS,PT

Provider Business Mailing Address
First Line	:	4674 SNOW MESA DR
Second Line	:	SUITE 140
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8615
Country	:	US
Telephone Number	:	970-266-3850
Fax Number	:	970-266-3855

Provider Business Practice Location Address
First Line	:	4674 SNOW MESA DR
Second Line	:	SUITE 140
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-8615
Country	:	US
Telephone Number	:	970-266-3850
Fax Number	:	970-266-3855

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	11/12/2007

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