Provider Demographics
NPI:1013076793
Name:ALVAREZ, MARYLOU (PT)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:ALVAREZ
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 1:3423 VALLE VERDE DR.
Mailing Address - Street 2:CO FUTURES REHAB, INC.
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2414
Mailing Address - Country:US
Mailing Address - Phone:707-254-7175
Mailing Address - Fax:
Practice Address - Street 1:3423 VALLE VERDE DR.
Practice Address - Street 2:CO FUTURES REHAB, INC.
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2414
Practice Address - Country:US
Practice Address - Phone:707-254-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT94450Medicare ID - Type Unspecified