Active NPI
Emmanuel Rivera
- Physical Therapy Assistant
- Fort Myers, FL
National Provider Identifier
1295331536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 30062
- Practice address
- 13921 Shell Point Boulevard
Fort Myers, FL 33908 - Phone
- (800) 780-1131
- NPI assigned
- Dec 10, 2020
- Last updated
- Dec 17, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 30062 | FL | Primary |
Addresses
Primary practice location
13921 Shell Point Boulevard
Fort Myers, FL 33908
Mailing address
352 Ringwood Cir
Winter Springs, FL 32708-4928
Phone (863) 605-1122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30062 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608163200000",
"number": "1295331536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "352 RINGWOOD CIR",
"city": "WINTER SPRINGS",
"state": "FL",
"postal_code": "327084928",
"telephone_number": "863-605-1122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13921 SHELL POINT BOULEVARD",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33908",
"telephone_number": "800-780-1131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "EMMANUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-10",
"last_updated": "2020-12-17",
"certification_date": "2020-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "30062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.