Provider Demographics
NPI:1447821335
Name:OLLECH, AUGUSTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:OLLECH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23555 N DESERT PEAK PKWY APT 623
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-6312
Mailing Address - Country:US
Mailing Address - Phone:303-834-0116
Mailing Address - Fax:
Practice Address - Street 1:14630 W PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4589
Practice Address - Country:US
Practice Address - Phone:623-594-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist