Individual
MS. REVAE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
805 E CROCKETT ST, CRYSTAL CITY, TX 78839-2711
(830) 374-2341
(830) 374-8012
Mailing address
PO BOX 630, CRYSTAL CITY, TX 78839-0630
(903) 504-7140
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT6340
TX
Other
Enumeration date
11/16/2015
Last updated
01/18/2021
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