Provider Demographics
NPI:1629558085
Name:OLMOS, ANTHONY M
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:OLMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 GATEWAY BLVD E STE 4A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1006
Mailing Address - Country:US
Mailing Address - Phone:915-779-7827
Mailing Address - Fax:
Practice Address - Street 1:6800 GATEWAY BLVD E STE 4A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1006
Practice Address - Country:US
Practice Address - Phone:915-779-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2123481225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant