Provider Demographics
NPI:1689040073
Name:DEESE, OLIVIA
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DEESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 GREYSTN COM BLVD
Mailing Address - Street 2:SUITE 34
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-9600
Mailing Address - Country:US
Mailing Address - Phone:205-745-3651
Mailing Address - Fax:
Practice Address - Street 1:4774 EASTERN VALLEY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-3564
Practice Address - Country:US
Practice Address - Phone:205-745-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist