Provider Demographics
NPI:1912223611
Name:OLORES, ROWENA REYES (PT)
Entity Type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:REYES
Last Name:OLORES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ROWENA
Other - Middle Name:BERNARDO
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4507 RISINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7338
Mailing Address - Country:US
Mailing Address - Phone:972-377-7448
Mailing Address - Fax:972-232-8099
Practice Address - Street 1:8000 FRANKFORD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6834
Practice Address - Country:US
Practice Address - Phone:972-232-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist