Provider Demographics
NPI:1831858844
Name:GERUSO, OLIVIA ANNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:ANNE
Last Name:GERUSO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 ONONDAGA BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3385
Mailing Address - Country:US
Mailing Address - Phone:315-475-7121
Mailing Address - Fax:
Practice Address - Street 1:4654 ONONDAGA BLVD # 1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3385
Practice Address - Country:US
Practice Address - Phone:315-475-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist