Provider Demographics
NPI:1356848634
Name:ALVARADO, NESTOR (PT)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:ALVARADO
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 1:350 N MAIN ST UNIT 611
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4124
Mailing Address - Country:US
Mailing Address - Phone:586-344-9875
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST UNIT 611
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-4124
Practice Address - Country:US
Practice Address - Phone:586-344-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist