Healthcare Provider Details

I. General information

NPI: 1538931597
Provider Name (Legal Business Name): OLIVIA WUEST PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/24/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

175 E 62ND ST APT 11D
NEW YORK NY
10065-7690
US

V. Phone/Fax

Practice location:
  • Phone: 646-618-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number048320-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: