Provider Demographics
NPI:1184161986
Name:CHRISTIAN OLIVARES PHYSICAL THERAPY SERVICES PC
Entity type:Organization
Organization Name:CHRISTIAN OLIVARES PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-542-3435
Mailing Address - Street 1:13915 34TH AVE
Mailing Address - Street 2:BASEMENT
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13915 34TH AVE
Practice Address - Street 2:BASEMENT
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3273
Practice Address - Country:US
Practice Address - Phone:347-542-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty