Provider Demographics
NPI:1679551766
Name:OLAECHEA, CARLOS (PT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:OLAECHEA
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 1:9260 SW 72ND ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3275
Mailing Address - Country:US
Mailing Address - Phone:305-554-8877
Mailing Address - Fax:305-554-8006
Practice Address - Street 1:9260 SW 72ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3275
Practice Address - Country:US
Practice Address - Phone:305-554-8877
Practice Address - Fax:305-554-8006
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9006ZOtherMEDICARE
FLY9006ZOtherMEDICARE