MEDICARE: ANTONIO R. OLIVAREZ LMT

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	225700000X	Massage Therapist	MT110494	TX

General Provider Information

NPI Number	:	1629751474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO R. OLIVAREZ LMT

Provider Business Mailing Address
First Line	:	5033 AVERY LN
Second Line	:
City	:	THE COLONY
State	:	TX
Zip	:	75056-2316
Country	:	US
Telephone Number	:	469-992-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5039 VILLAGE CREEK DR.
Second Line	:	SUITE 300
City	:	PLANO
State	:	TX
Zip	:	75093
Country	:	US
Telephone Number	:	469-992-3056
Fax Number	:

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

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	10/30/2025

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