Provider Demographics
NPI:1407278500
Name:HALLAM, OLGA (PT)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:HALLAM
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 1:54 VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-4136
Mailing Address - Country:US
Mailing Address - Phone:925-376-0244
Mailing Address - Fax:925-376-0244
Practice Address - Street 1:54 VALENCIA RD
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-4136
Practice Address - Country:US
Practice Address - Phone:925-376-0244
Practice Address - Fax:925-376-0244
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist