Provider Demographics
NPI:1932394723
Name:OLOSOMA THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:OLOSOMA THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:623-363-9545
Mailing Address - Street 1:15623 N 174TH AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-0263
Mailing Address - Country:US
Mailing Address - Phone:623-363-9545
Mailing Address - Fax:602-926-1402
Practice Address - Street 1:15623 N 174TH AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-0263
Practice Address - Country:US
Practice Address - Phone:623-363-9545
Practice Address - Fax:602-926-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health