Provider Demographics
NPI:1164475141
Name:ASHLEY, OLIVIA (PT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:STE 330
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2204
Mailing Address - Country:US
Mailing Address - Phone:781-961-9200
Mailing Address - Fax:781-961-6599
Practice Address - Street 1:191 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2571
Practice Address - Country:US
Practice Address - Phone:617-630-9778
Practice Address - Fax:617-930-5202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA17426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69731Medicare ID - Type Unspecified