Provider Demographics
NPI:1295563781
Name:SPUNG, OLIVIA ESHAYA (ALABAMA PTA11762)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ESHAYA
Last Name:SPUNG
Suffix:
Gender:F
Credentials:ALABAMA PTA11762
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:584 WOODLAND RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ODENVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35120-6774
Mailing Address - Country:US
Mailing Address - Phone:303-888-7496
Mailing Address - Fax:
Practice Address - Street 1:650 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4502
Practice Address - Country:US
Practice Address - Phone:205-305-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA11762225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant