Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2320 | KY |
N | 226300000X | Kinesiotherapist |
NPI | 1558693432 |
---|---|
Provider Name | Debora Marie Rivera |
First Address | Louisville, KY 40223-1062 |
Second Address | Louisville, KY 40207-4020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2010 |
Last Update Date | 23/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210614 | AMTA (01) | KY |
549723-07 | NCBTMB (01) |