Provider Demographics
NPI:1497551360
Name:ELLIOTT, OLIVIA (PTA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OLIVIA MURPHY
Mailing Address - Street 1:3861 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3107
Mailing Address - Country:US
Mailing Address - Phone:781-974-9648
Mailing Address - Fax:
Practice Address - Street 1:4060 FOURTH AVE STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2120
Practice Address - Country:US
Practice Address - Phone:619-299-5246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52668225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant