Provider Demographics
NPI:1336695790
Name:MCCANN, OLIVIA M (DPT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:MCCANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:M
Other - Last Name:DALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4414
Mailing Address - Country:US
Mailing Address - Phone:267-339-3603
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-339-3500
Practice Address - Fax:215-503-0580
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist