Provider Demographics
NPI:1619608569
Name:MCNAMER, OLIVIA CHASE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CHASE
Last Name:MCNAMER
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 1:130 MATTHEW ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1471
Mailing Address - Country:US
Mailing Address - Phone:925-451-4105
Mailing Address - Fax:
Practice Address - Street 1:310 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2638
Practice Address - Country:US
Practice Address - Phone:203-654-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist