Provider Demographics
NPI:1437207198
Name:OLIVAREZ-SMITH, ALICIA (PT)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:
Last Name:OLIVAREZ-SMITH
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 1:1637 QUESTA RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-6324
Mailing Address - Country:US
Mailing Address - Phone:505-890-1653
Mailing Address - Fax:
Practice Address - Street 1:10511 GOLF COURSE RD NW
Practice Address - Street 2:STE 104
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5916
Practice Address - Country:US
Practice Address - Phone:505-727-2123
Practice Address - Fax:505-727-2187
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist