Provider Demographics
NPI:1124528518
Name:OLIVAS, EMILY CAMILLE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAMILLE
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 MANCHESTER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78737-4543
Mailing Address - Country:US
Mailing Address - Phone:512-644-7281
Mailing Address - Fax:512-597-3212
Practice Address - Street 1:14121 W HWY 290 STE 2B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-9397
Practice Address - Country:US
Practice Address - Phone:512-644-7368
Practice Address - Fax:512-644-7368
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10967332251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics