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General NPI Number Information
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NPI Number | 1124528518
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Entity Type | Individual
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Provider Name | EMILY CAMILLE OLIVAS
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Gender | Female
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 14121 W HWY 290 STE 2B
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City | AUSTIN
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State | TX
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Zip | 78737-9397
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Country | US
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Telephone | 512-644-7368
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Fax | 512-644-7368
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Provider Business Mailing Address
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Address Line | 561 MANCHESTER LN
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City | AUSTIN
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State | TX
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Zip | 78737-4543
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Country | US
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Telephone | 512-644-7281
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Fax | 512-597-3212
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1096733
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License Number State | TX
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