Provider Demographics
NPI:1871805929
Name:DIMAKILING, OLGA V (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:V
Last Name:DIMAKILING
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5392
Mailing Address - Country:US
Mailing Address - Phone:248-346-0489
Mailing Address - Fax:
Practice Address - Street 1:1421 OGDEN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5392
Practice Address - Country:US
Practice Address - Phone:248-346-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI550009875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist