Provider Demographics
NPI:1659038537
Name:MAGANN, OLIVIA PERRAL (PT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PERRAL
Last Name:MAGANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:BOHOLST
Other - Last Name:PERRAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4221 W SPRUCE ST APT 2303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-7245
Mailing Address - Country:US
Mailing Address - Phone:813-407-7773
Mailing Address - Fax:
Practice Address - Street 1:1450 VENICE ROAD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292
Practice Address - Country:US
Practice Address - Phone:919-424-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist