Provider Demographics
NPI:1619600343
Name:RICKEY, OLIVIA MARGARET (PT, DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARGARET
Last Name:RICKEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 FLORIDA ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-7205
Mailing Address - Country:US
Mailing Address - Phone:509-969-2822
Mailing Address - Fax:
Practice Address - Street 1:1333 CAMINO DEL RIO S STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3520
Practice Address - Country:US
Practice Address - Phone:619-501-2195
Practice Address - Fax:619-501-2176
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist