Provider Demographics
NPI:1033664974
Name:OLEARY, PATRICIA (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OLEARY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 E RIVERSONG DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5568
Mailing Address - Country:US
Mailing Address - Phone:707-934-5595
Mailing Address - Fax:
Practice Address - Street 1:1240 E RIVERSONG DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5568
Practice Address - Country:US
Practice Address - Phone:707-934-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-423225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant