Provider Demographics
NPI:1184004376
Name:OLAYVAR, ROBERTO CASTILLO (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CASTILLO
Last Name:OLAYVAR
Suffix:
Gender:M
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:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-6027
Mailing Address - Country:US
Mailing Address - Phone:740-432-4824
Mailing Address - Fax:740-432-4004
Practice Address - Street 1:59302 CLAYSVILLE RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9340
Practice Address - Country:US
Practice Address - Phone:740-432-4824
Practice Address - Fax:740-432-4004
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3759208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation