Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 929 | PR |
N | 2251S0007X | Physical Therapist - Sports | 929 | PR |
NPI | 1245448059 |
---|---|
Provider Name | Mr. Carlos Jose Rivera |
First Address | San Juan, PR 00926 |
Second Address | San Juan, PR 00926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |