Healthcare Provider Details

I. General information

NPI: 1114167996
Provider Name (Legal Business Name): STEPHEN R OLBRISH JR. RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2558 ABBEY CT
ROCKWALL TX
75032-7368
US

IV. Provider business mailing address

2558 ABBEY CT
ROCKWALL TX
75032
US

V. Phone/Fax

Practice location:
  • Phone: 972-722-8261
  • Fax:
Mailing address:
  • Phone: 972-722-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278E1000X
TaxonomyEducational Certified Respiratory Therapist
License Number55666
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2278G0305X
TaxonomyGeriatric Care Certified Respiratory Therapist
License Number55666
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number55666
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number55666
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number55666
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number55666
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number55666
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code2279S1500X
TaxonomySNF/Subacute Care Registered Respiratory Therapist
License Number55666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: