Provider Demographics
NPI:1720290018
Name:STARACE, OLIVIA ELENA (PT-ASSIST)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ELENA
Last Name:STARACE
Suffix:
Gender:F
Credentials:PT-ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81031 AURORA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6628
Mailing Address - Country:US
Mailing Address - Phone:760-775-0221
Mailing Address - Fax:
Practice Address - Street 1:22365 BARTON RD
Practice Address - Street 2:#212
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5015
Practice Address - Country:US
Practice Address - Phone:909-885-5357
Practice Address - Fax:909-885-8112
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 1022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant