Basic Information
| Provider Information | |||||||||
| NPI: | 1023323268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVAS | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | MARTINEZ | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8725 S KYRENE RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807568617 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8725 S KYRENE RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852842116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807568617 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9003 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.