Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1096733 | TX |
NPI | 1124528518 |
---|---|
Provider Name | Emily Camille Olivas |
First Address | Austin, TX 78737-4543 |
Second Address | Austin, TX 78737-9397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 13/02/2018 |