MEDICARE: JAMIE ALVAREZ PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2004023365	MO

General Provider Information

NPI Number	:	1467227280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE ALVAREZ PTA

Provider Business Mailing Address
First Line	:	3120 SW TIARA LN
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4134
Country	:	US
Telephone Number	:	816-719-7420
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 MILL ST
Second Line	:
City	:	BELTON
State	:	MO
Zip	:	64012-3403
Country	:	US
Telephone Number	:	816-348-1514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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