Healthcare Provider Details

I. General information

NPI: 1124561436
Provider Name (Legal Business Name): JOSE ALFREDO OLMEDA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 N JACKSON RD
PHARR TX
78577-4962
US

IV. Provider business mailing address

539 BARTON DR
EDINBURG TX
78541-1300
US

V. Phone/Fax

Practice location:
  • Phone: 956-683-9339
  • Fax:
Mailing address:
  • Phone: 956-292-6033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: