Provider Demographics
NPI:1912776931
Name:GIAMMALVA, OLIVIA JO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:JO
Last Name:GIAMMALVA
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 1:157 WINDING WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8021
Mailing Address - Country:US
Mailing Address - Phone:810-986-0877
Mailing Address - Fax:
Practice Address - Street 1:5220 W INDIAN SCHOOL RD.
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031
Practice Address - Country:US
Practice Address - Phone:623-691-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015031A225100000X
MI5501302531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist