MEDICARE: OLIVIA DEHAN

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	PT014847	GA

General Provider Information

NPI Number	:	1750047445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA DEHAN

Provider Business Mailing Address
First Line	:	1805 VERNON RD
Second Line	:	STE A
City	:	LAGRANGE
State	:	GA
Zip	:	30240-3871
Country	:	US
Telephone Number	:	706-845-9383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 13TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1908
Country	:	US
Telephone Number	:	706-315-8175
Fax Number	:

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

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	01/20/2022

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Directions to “ OLIVIA DEHAN ” Practice Location

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