Healthcare Provider Details

I. General information

NPI: 1497679377
Provider Name (Legal Business Name): OLIVIA KAELEE DUPRE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA GASSMAN

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 GREENWOOD AVE
WEST PALM BCH FL
33407-2442
US

IV. Provider business mailing address

9873 LAWRENCE RD APT H304
BOYNTON BEACH FL
33436-3822
US

V. Phone/Fax

Practice location:
  • Phone: 561-882-6347
  • Fax:
Mailing address:
  • Phone: 904-699-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: