Provider Demographics
NPI:1467227280
Name:ALVAREZ, JAMIE (PTA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 SW TIARA LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4134
Mailing Address - Country:US
Mailing Address - Phone:816-719-7420
Mailing Address - Fax:
Practice Address - Street 1:614 MILL ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-3403
Practice Address - Country:US
Practice Address - Phone:816-348-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004023365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant