Provider Demographics
NPI:1487933230
Name:FREDMAN, RIVKA TOVA (PT)
Entity type:Individual
Prefix:MS
First Name:RIVKA
Middle Name:TOVA
Last Name:FREDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 BAILEY CT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1632
Mailing Address - Country:US
Mailing Address - Phone:718-868-1780
Mailing Address - Fax:
Practice Address - Street 1:2917 BAILEY CT
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1632
Practice Address - Country:US
Practice Address - Phone:718-868-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist