Provider Demographics
NPI:1831337138
Name:OLLILA, ANITA (PT)
Entity type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:
Last Name:OLLILA
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 1:303 BALCH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2706
Mailing Address - Country:US
Mailing Address - Phone:269-343-7100
Mailing Address - Fax:269-343-1330
Practice Address - Street 1:303 BALCH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2706
Practice Address - Country:US
Practice Address - Phone:269-343-7100
Practice Address - Fax:269-343-1330
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist