Healthcare Provider Details

I. General information

NPI: 1710316443
Provider Name (Legal Business Name): OLIVE FRIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 10/08/2023
Certification Date: 10/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 11TH ST
CEDAR FALLS IA
50613-3364
US

IV. Provider business mailing address

1939 COLLEGE ST APT 228
CEDAR FALLS IA
50613-3668
US

V. Phone/Fax

Practice location:
  • Phone: 319-277-2141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005075
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3224
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: