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General NPI Number Information
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NPI Number | 1932394723
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Entity Type | Organization
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Legal Business Name | OLOSOMA THERAPY SERVICES, INC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 15623 N 174TH AVE
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City | SURPRISE
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State | AZ
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Zip | 85388-0263
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Country | US
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Telephone | 623-363-9545
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Fax | 602-926-1402
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Provider Business Mailing Address
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Address Line | 15623 N 174TH AVE
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City | SURPRISE
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State | AZ
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Zip | 85388-0263
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Country | US
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Telephone | 623-363-9545
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Fax | 602-926-1402
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RACHELLE LYNN BAKER
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Credential | D.P.T.
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Telephone | 623-363-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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