Provider Demographics
NPI:1760705750
Name:CHRISTIAN OLIVARES PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:CHRISTIAN OLIVARES PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-461-5900
Mailing Address - Street 1:3910 MAIN ST
Mailing Address - Street 2:SUITE #303
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5403
Mailing Address - Country:US
Mailing Address - Phone:718-461-5900
Mailing Address - Fax:718-461-4833
Practice Address - Street 1:3910 MAIN ST
Practice Address - Street 2:SUITE #303
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5403
Practice Address - Country:US
Practice Address - Phone:718-461-5900
Practice Address - Fax:718-461-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty