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General NPI Number Information
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NPI Number | 1437043189
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Entity Type | Individual
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Provider Name | JATHZEEL AMADEO OLIVARES DPT
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Gender | Male
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 417 W YELM AVE
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City | YELM
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State | WA
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Zip | 98597
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Country | US
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Telephone | 360-458-2444
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Fax | 360-458-2747
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Provider Business Mailing Address
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Address Line | 100 DENNIS ST SW STE B
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City | TUMWATER
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State | WA
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Zip | 98501-6523
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Country | US
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Telephone | 360-338-0181
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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