Provider Demographics
NPI:1417479221
Name:BROWN, OLIVIA DIANE (PT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DIANE
Last Name:BROWN
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 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:
Practice Address - Street 1:4301 PENN AVE
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1370
Practice Address - Country:US
Practice Address - Phone:610-927-4136
Practice Address - Fax:610-927-4139
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025998225100000X
DEJ1-0003697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT025998OtherSTATE