Healthcare Provider Details

I. General information

NPI: 1629558085
Provider Name (Legal Business Name): ANTHONY M OLMOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 GATEWAY BLVD E STE 4A
EL PASO TX
79915-1006
US

IV. Provider business mailing address

6800 GATEWAY BLVD E STE 4A
EL PASO TX
79915-1006
US

V. Phone/Fax

Practice location:
  • Phone: 915-779-7827
  • Fax:
Mailing address:
  • Phone: 915-779-7827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2123481
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: