MEDICARE: MR. CRISTIAN S. OLIVARES P.T.

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	225100000X	Physical Therapist	1146221	TX
2	225100000X	Physical Therapist	PTL.0020213	CO

General Provider Information

NPI Number	:	1942441530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRISTIAN S. OLIVARES P.T.

Provider Business Mailing Address
First Line	:	5945 NORA PT APT 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3766
Country	:	US
Telephone Number	:	361-484-1269
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 AUSTIN BLUFFS PKWY
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2932
Country	:	US
Telephone Number	:	719-475-0808
Fax Number	:

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	11/19/2025

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