Provider Demographics
NPI:1134990898
Name:ALVAREZ, JUAN MANUEL (PTA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:MANUEL
Other - Last Name:ALVAREZ LUCIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:704 S TRENCHARD ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-2177
Mailing Address - Country:US
Mailing Address - Phone:940-577-1504
Mailing Address - Fax:
Practice Address - Street 1:609 MEDICAL CENTER DR BLDG 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3866
Practice Address - Country:US
Practice Address - Phone:940-626-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2157321225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant