MEDICARE: DIEDRA OLIN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006303	GA

General Provider Information

NPI Number	:	1417094640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEDRA OLIN PT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	866-518-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	2295 TOWNE LAKE PKWY STE 148
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-5520
Country	:	US
Telephone Number	:	770-926-2744
Fax Number	:	770-926-2794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	03/13/2023

Similar Medicare Providers

1518820216 — AERYN MACKENSI PHILLIPS
Practice Location Address:

2295 TOWNE LAKE PKWY
WOODSTOCK, GA
30189-5520

Practice Phone: 770-517-2088
Practice Fax:

1720012560 — THE KROGER CO
Practice Location Address:

2295 TOWNE LAKE PKWY
WOODSTOCK, GA
30189-5520

Practice Phone: 770-517-2088
Practice Fax: 770-517-1087

1275552499 — GREGORY PAUL VESCERA PT, DPT
Practice Location Address:

2295 TOWNE LAKE PKWY STE 148
WOODSTOCK, GA
30189-5520

Practice Phone: 770-926-2744
Practice Fax: 770-926-2794

1356434302 — DR. JASON LEE KELSEY DPT
Practice Location Address:

2295 TOWNE LAKE PKWY , SUITE 148
WOODSTOCK, GA
30189-5520

Practice Phone: 770-926-2744
Practice Fax: 770-926-2794

1386723641 — YVETTE SHEA STRICKLAND PT, DPT
Practice Location Address:

2295 TOWNE LAKE PKWY STE 148
WOODSTOCK, GA
30189-5520

Practice Phone: 770-926-2744
Practice Fax: 770-926-2794

1619150232 — NORTHERN PROFESSIONAL CENTER INC
Practice Location Address:

2295 TOWNE LAKE PKWY , SUITE 116-142
WOODSTOCK, GA
30189-5520

Practice Phone: 912-322-3374
Practice Fax:

Directions to “ DIEDRA OLIN PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.