Healthcare Provider Details

I. General information

NPI: 1275430548
Provider Name (Legal Business Name): KRISTEN OLIVA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2026
Last Update Date: 10/21/2026
Certification Date: 10/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 VETERANS RD W BLDG SUITE
STATEN ISLAND NY
10309-2517
US

IV. Provider business mailing address

34 MADSEN AVE
STATEN ISLAND NY
10309-2608
US

V. Phone/Fax

Practice location:
  • Phone: 718-874-1012
  • Fax:
Mailing address:
  • Phone: 917-991-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: