=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154246700
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVIA WANG DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2026
-----------------------------------------------------
Last Update Date | 08/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 295 FOSTER ST # 100
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01460-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-795-4131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 497 ACORN PARK DR
-----------------------------------------------------
City | ACTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01720-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-760-7088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTL89635
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------