Provider Demographics
NPI:1285124149
Name:OLIVER, MIA KATHERINE (DPT)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:KATHERINE
Last Name:OLIVER
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:957 MINOR ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2930
Mailing Address - Country:US
Mailing Address - Phone:251-404-1626
Mailing Address - Fax:
Practice Address - Street 1:11840 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3459
Practice Address - Country:US
Practice Address - Phone:424-269-3400
Practice Address - Fax:310-882-5451
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPT42874225100000X
CA296400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty