Provider Demographics
NPI:1154087518
Name:OLEA, THALITA CAVALCANTE (PT)
Entity type:Individual
Prefix:
First Name:THALITA
Middle Name:CAVALCANTE
Last Name:OLEA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1267 W EXCHANGE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7111
Practice Address - Country:US
Practice Address - Phone:469-342-0641
Practice Address - Fax:972-833-6079
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1340008OtherPHYSICAL THERAPY BOARD