Provider Demographics
NPI:1518674555
Name:CHINN, OLIVIA JEAN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JEAN
Last Name:CHINN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 WOODVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8851
Mailing Address - Country:US
Mailing Address - Phone:330-978-7219
Mailing Address - Fax:
Practice Address - Street 1:4953 WOODVIEW RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-8851
Practice Address - Country:US
Practice Address - Phone:330-978-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT01988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist