Provider Demographics
NPI:1740873900
Name:BIDDLE, OLIVIA (LMT, NYS)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:
Last Name:BIDDLE
Suffix:
Gender:F
Credentials:LMT, NYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WEST END AVE
Mailing Address - Street 2:#2707
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:917-496-5538
Mailing Address - Fax:
Practice Address - Street 1:21 WEST END AVE
Practice Address - Street 2:#2707
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:917-496-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014706-3225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist