Provider Demographics
NPI:1144529744
Name:HALL, OLIVIA C (BS PT)
Entity type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S IVANHOE WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1975
Mailing Address - Country:US
Mailing Address - Phone:303-993-3146
Mailing Address - Fax:
Practice Address - Street 1:1255 S IVANHOE WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1975
Practice Address - Country:US
Practice Address - Phone:303-993-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22Medicare UPIN