Provider Demographics
NPI:1578720330
Name:WEBSTER, OLIVIA JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JEAN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CRESCENT DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-6816
Mailing Address - Country:US
Mailing Address - Phone:310-273-0877
Mailing Address - Fax:
Practice Address - Street 1:415 N CRESCENT DR STE 130
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6816
Practice Address - Country:US
Practice Address - Phone:310-273-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902017411OtherORGANIZATION NPI
CA1104017730OtherORGANIZATION NPI
CAW14547AMedicare PIN