Healthcare Provider Details

I. General information

NPI: 1316832025
Provider Name (Legal Business Name): OLIVIA GUH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 NY RT 9D
WAPPINGER FALLS NY
12590
US

IV. Provider business mailing address

4 PERRINS MEWS
MIDDLETOWN NY
10940-3555
US

V. Phone/Fax

Practice location:
  • Phone: 845-414-6780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number012677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: