Active NPI
Judah Tomas Olivas
- Physical Therapy Assistant
- Tucson, AZ
National Provider Identifier
1659940138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA31109
- Practice address
- 11012 N Divot Dr
Tucson, AZ 85737-7231 - Phone
- (520) 365-8155
- NPI assigned
- Jun 21, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA31109 | FL | Primary |
Addresses
Primary practice location
11012 N Divot Dr
Tucson, AZ 85737-7231
Mailing address
11012 N Divot Dr
Tucson, AZ 85737-7231
Phone (520) 365-8155
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA31109 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624233600000",
"number": "1659940138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11012 N DIVOT DR",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857377231",
"telephone_number": "520-365-8155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11012 N DIVOT DR",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857377231",
"telephone_number": "520-365-8155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVAS",
"first_name": "JUDAH",
"middle_name": "TOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-21",
"last_updated": "2021-06-21",
"certification_date": "2021-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA31109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.