Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 27167 | CA |
N | 2251S0007X | Physical Therapist - Sports | CA |
NPI | 1235351586 |
---|---|
Provider Name | Kelly Denise Olin |
First Address | Torrance, CA 90505-4716 |
Second Address | Torrance, CA 90505-4716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 13/01/2017 |