Healthcare Provider Details

I. General information

NPI: 1235994641
Provider Name (Legal Business Name): OLVE PEDIATRIC THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9918 E THEIA DR
MESA AZ
85212-8494
US

IV. Provider business mailing address

9918 E THEIA DR
MESA AZ
85212-8494
US

V. Phone/Fax

Practice location:
  • Phone: 480-242-3395
  • Fax:
Mailing address:
  • Phone: 480-242-3395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS WILLIAM ANDERSEN
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 480-242-3395