Provider Demographics
NPI:1083366561
Name:BOLES, OLIVIA CATHRYN (DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CATHRYN
Last Name:BOLES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3309 BONDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8904
Mailing Address - Country:US
Mailing Address - Phone:423-946-1948
Mailing Address - Fax:
Practice Address - Street 1:3135 PEOPLES ST STE 404
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4138
Practice Address - Country:US
Practice Address - Phone:423-454-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist