Provider Demographics
NPI:1124785456
Name:OLEXSOVICH, THOMAS (DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:OLEXSOVICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 FIRETHORN RD
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-2619
Mailing Address - Country:US
Mailing Address - Phone:724-290-9159
Mailing Address - Fax:
Practice Address - Street 1:1838 GREENE TREE RD STE 245
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7110
Practice Address - Country:US
Practice Address - Phone:410-753-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214770225100000X
MD29789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist