Provider Demographics
NPI:1447324769
Name:OLMOS, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:OLMOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 EDINBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8495
Mailing Address - Country:US
Mailing Address - Phone:919-941-6034
Mailing Address - Fax:
Practice Address - Street 1:2605 BLUE RIDGE RD STE 230
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6475
Practice Address - Country:US
Practice Address - Phone:919-781-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP10775OtherLICENSE#