Provider Demographics
NPI:1134559339
Name:RIVA, GIOVANNI (CMT)
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:RIVA
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-1963
Mailing Address - Country:US
Mailing Address - Phone:952-474-4121
Mailing Address - Fax:952-474-8391
Practice Address - Street 1:464 2ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1963
Practice Address - Country:US
Practice Address - Phone:952-474-4121
Practice Address - Fax:952-474-8391
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist