Provider Demographics
NPI:1689067480
Name:OVIYUS, ALEJANDRA M (PT)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:M
Last Name:OVIYUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 ROTTERDAM RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6416
Mailing Address - Country:US
Mailing Address - Phone:317-403-4160
Mailing Address - Fax:317-288-4014
Practice Address - Street 1:14320 ROTTERDAM RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6416
Practice Address - Country:US
Practice Address - Phone:317-403-4160
Practice Address - Fax:317-288-4014
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011411A225100000X
FLPT 29065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist