Healthcare Provider Details

I. General information

NPI: 1518182823
Provider Name (Legal Business Name): MELISSA OLMOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 WEST TALCOTT
CHICAGO IL
60631
US

IV. Provider business mailing address

7278 W EVERELL
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 773-594-7838
  • Fax: 773-594-7835
Mailing address:
  • Phone: 773-775-2268
  • Fax: 773-775-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: