Healthcare Provider Details

I. General information

NPI: 1275759938
Provider Name (Legal Business Name): DIANE M OLIMPIO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

764 HOPKINTON RD
HOPKINTON NH
03229-2633
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-4610
  • Fax:
Mailing address:
  • Phone: 603-225-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0589
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: