Provider Demographics
NPI:1558519942
Name:ALVAREZ, JAMIE (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:ALVAREZ
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 1:114 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-4552
Mailing Address - Country:US
Mailing Address - Phone:325-236-6821
Mailing Address - Fax:325-236-6112
Practice Address - Street 1:114 LOCUST ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-4552
Practice Address - Country:US
Practice Address - Phone:325-236-6821
Practice Address - Fax:325-236-6112
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist