Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1162620 | TX |
NPI | 1992977268 |
---|---|
Provider Name | Mr. Jerry James Rivera |
First Address | San Antonio, TX 78229-4801 |
Second Address | San Antonio, TX 78229-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 27/03/2008 |