Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 005978-1 | NY |
NPI | 1063799021 |
---|---|
Provider Name | Gloria Maria Rivera |
First Address | Plainview, NY 11803-1420 |
Second Address | Massapequa Park, NY 11762-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2011 |
Last Update Date | 04/11/2011 |