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General NPI Number Information
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NPI Number | 1235994641
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Entity Type | Organization
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Legal Business Name | OLVE PEDIATRIC THERAPY PLLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 9918 E THEIA DR
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City | MESA
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State | AZ
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Zip | 85212-8494
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Country | US
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Telephone | 480-242-3395
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Fax |
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Provider Business Mailing Address
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Address Line | 9918 E THEIA DR
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City | MESA
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State | AZ
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Zip | 85212-8494
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Country | US
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Telephone | 480-242-3395
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | NICHOLAS WILLIAM ANDERSEN
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Credential | PT, DPT
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Telephone | 480-242-3395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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