Provider Demographics
NPI:1003793449
Name:RIVERA, KYANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYANNA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:KYANNA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7809 CREEK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-7951
Mailing Address - Country:US
Mailing Address - Phone:914-484-8279
Mailing Address - Fax:
Practice Address - Street 1:6913 JESSICA CT
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-3667
Practice Address - Country:US
Practice Address - Phone:979-422-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1407179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist