Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 001636 | CT |
NPI | 1003273301 |
---|---|
Provider Name | Ms. Victoria Rivera |
First Address | Waterbury, CT 06708-1458 |
Second Address | Waterbury, CT 06708-1458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 10/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004190328 | (05) | CT |