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General NPI Number Information
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NPI Number | 1629751474
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Entity Type | Individual
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Provider Name | ANTONIO R. OLIVAREZ LMT
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Gender | Male
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 5039 VILLAGE CREEK DR. SUITE 300
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City | PLANO
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State | TX
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Zip | 75093
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Country | US
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Telephone | 469-992-3056
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Fax |
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Provider Business Mailing Address
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Address Line | 5033 AVERY LN
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City | THE COLONY
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State | TX
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Zip | 75056-2316
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Country | US
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Telephone | 469-992-3056
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT110494
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License Number State | TX
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