Healthcare Provider Details

I. General information

NPI: 1295644532
Provider Name (Legal Business Name): MANUEL ANIBAL OLEA BELTRAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 W ALTO PL
TUCSON AZ
85705-7213
US

IV. Provider business mailing address

617 W ALTO PL
TUCSON AZ
85705-7213
US

V. Phone/Fax

Practice location:
  • Phone: 520-390-6001
  • Fax:
Mailing address:
  • Phone: 520-390-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: