Provider Demographics
NPI:1154087518
Name:OLEA, THALITA C (PT)
Entity Type:Individual
Prefix:
First Name:THALITA
Middle Name:C
Last Name:OLEA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 ELDORADO PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-8069
Mailing Address - Country:US
Mailing Address - Phone:972-658-3299
Mailing Address - Fax:
Practice Address - Street 1:1701 ELDORADO PKWY STE 202
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-8069
Practice Address - Country:US
Practice Address - Phone:972-658-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1340008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1340008OtherPHYSICAL THERAPY BOARD