Provider Demographics
NPI:1174563613
Name:ALVAREZ, ERICK (PT)
Entity type:Individual
Prefix:MR
First Name:ERICK
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13616 CALIFORNA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:402-496-5556
Mailing Address - Fax:402-496-0517
Practice Address - Street 1:13616 CALIFORNA STREET
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-496-5556
Practice Address - Fax:402-496-0517
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE68154A024OtherTRICARE
NE279997OtherMEDICARE
NE02110OtherBCBS
NEP00336407OtherRR MEDICARE