Provider Demographics
NPI:1447033022
Name:WAIGHT, OLIVIA (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:WAIGHT
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9335 S 78TH CT
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2129
Mailing Address - Country:US
Mailing Address - Phone:708-710-5344
Mailing Address - Fax:
Practice Address - Street 1:11935 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-7218
Practice Address - Country:US
Practice Address - Phone:708-645-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist