Healthcare Provider Details

I. General information

NPI: 1366935462
Provider Name (Legal Business Name): JAIME EDUARDO OLMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E 2ND ST
DUMAS TX
79029-3808
US

IV. Provider business mailing address

708 DURRETT AVE
DUMAS TX
79029-4521
US

V. Phone/Fax

Practice location:
  • Phone: 806-934-6018
  • Fax:
Mailing address:
  • Phone: 806-930-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2137397
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: