Provider Demographics
NPI:1548037187
Name:ALVAREZ, ALEX FERNANDO (ATC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:FERNANDO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROYCE CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2270
Mailing Address - Country:US
Mailing Address - Phone:860-487-9200
Mailing Address - Fax:
Practice Address - Street 1:2095 HILLSIDE RD UNIT 1110
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1110
Practice Address - Country:US
Practice Address - Phone:860-486-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer