Provider Demographics
NPI:1477968220
Name:ALVAREZ, JAIME MATHEW (PTA)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:MATHEW
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 ALANA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4140
Mailing Address - Country:US
Mailing Address - Phone:904-318-3846
Mailing Address - Fax:
Practice Address - Street 1:7009 ALANA RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4140
Practice Address - Country:US
Practice Address - Phone:904-318-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24347225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant