Provider Demographics
NPI:1942441530
Name:OLIVARES, CRISTIAN S (PT)
Entity Type:Individual
Prefix:MR
First Name:CRISTIAN
Middle Name:S
Last Name:OLIVARES
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 1:6280 MCNEIL DR APT 903
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-6909
Mailing Address - Country:US
Mailing Address - Phone:361-484-1269
Mailing Address - Fax:
Practice Address - Street 1:6909 BURNET LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-2430
Practice Address - Country:US
Practice Address - Phone:512-452-5719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist