Provider Demographics
NPI:1598077505
Name:OLIVE, KATHRYN PRESTON (PT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PRESTON
Last Name:OLIVE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LINDSAY
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8010 ROSWELL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-7013
Mailing Address - Country:US
Mailing Address - Phone:770-360-9271
Mailing Address - Fax:
Practice Address - Street 1:8010 ROSWELL RD STE 120
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-7013
Practice Address - Country:US
Practice Address - Phone:770-360-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12694225100000X
GAPT015227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist