Provider Demographics
NPI:1124882220
Name:DEAN, OLIVIA (DPT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:MAIOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12072 W MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2462
Mailing Address - Country:US
Mailing Address - Phone:208-939-0533
Mailing Address - Fax:
Practice Address - Street 1:12072 W MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2462
Practice Address - Country:US
Practice Address - Phone:208-939-0533
Practice Address - Fax:208-939-3341
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist