Active NPI
Ryan Lainez Rivadelo
- Physical Therapist
- Henderson, NV
National Provider Identifier
1780210799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3005
- Practice address
- 264 Sweet Jewel St
Henderson, NV 89074-8042 - Phone
- (708) 890-1090
- NPI assigned
- Mar 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
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 Therapist | 225100000X | 3005 | NV | Primary |
Addresses
Primary practice location
264 Sweet Jewel St
Henderson, NV 89074-8042
Mailing address
264 Sweet Jewel St
Henderson, NV 89074-8042
Phone (708) 890-1090
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 |
|---|---|---|---|
| 3005 | NV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapy Blocks L.L.C. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584748800000",
"number": "1780210799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "264 SWEET JEWEL ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890748042",
"telephone_number": "708-890-1090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "264 SWEET JEWEL ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890748042",
"telephone_number": "708-890-1090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVADELO",
"first_name": "RYAN",
"middle_name": "LAINEZ",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-21",
"last_updated": "2020-03-21",
"certification_date": "2020-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "3005",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.