Provider Demographics
NPI:1245797141
Name:OLENA, ALEESHA RACHELLE
Entity Type:Individual
Prefix:
First Name:ALEESHA
Middle Name:RACHELLE
Last Name:OLENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:NE
Mailing Address - Zip Code:68980-0162
Mailing Address - Country:US
Mailing Address - Phone:402-460-8255
Mailing Address - Fax:
Practice Address - Street 1:510 CENTENNIAL CIR
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6586
Practice Address - Country:US
Practice Address - Phone:308-534-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1730225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty