Active NPI
Santos Rivera III, PTA
- Physical Therapy Assistant
- Savannah, GA
National Provider Identifier
1740652056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 003117
- Practice address
- 1128 E Derenne Ave
Savannah, GA 31406 - Phone
- (912) 344-4973
- NPI assigned
- Oct 26, 2015
- 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 | PTA 003117 | GA | Primary |
Addresses
Primary practice location
1128 E Derenne Ave
Savannah, GA 31406
Mailing address
12 Summer Lake Way
Savannah, GA 31407-3544
Phone (912) 224-7544
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 |
|---|---|---|---|
| PTA 003117 | GA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445817600000",
"number": "1740652056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 SUMMER LAKE WAY",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314073544",
"telephone_number": "912-224-7544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1128 E DERENNE AVE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "31406",
"telephone_number": "912-344-4973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVERA",
"first_name": "SANTOS",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-26",
"last_updated": "2015-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA 003117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
- Javier Rivera-Reyes
- Aritza Vanessa C Rivera
- Carlos A Rivera, M.D.
- Dominic Rivera, MSN, APRN, AGACNP-BC
- Milagros Rivera, MD
- Rivers Home Care Service, LLC.
- Octavia Rivers, CNA
- Riverview Health & Rehabilitation Center, Inc (None)
- Riverview Health and Rehabilitation Center, Inc.
- Riverview Health and Rehabilitation Center, Inc. (Riverview Health and Rehabilitation Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.