Provider Demographics
NPI:1336473693
Name:BARRY, OLIVIA KATHLEEN (PT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KATHLEEN
Last Name:BARRY
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8074 YULE TREE LN
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4903
Mailing Address - Country:US
Mailing Address - Phone:310-968-6809
Mailing Address - Fax:
Practice Address - Street 1:8074 YULE TREE LN
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4903
Practice Address - Country:US
Practice Address - Phone:310-968-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist