Provider Demographics
NPI:1487383006
Name:BERRY HAIGHT, OLIVIA TESS (DPT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:TESS
Last Name:BERRY HAIGHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:TESS
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:15204 OMEGA DR STE 310
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4816
Mailing Address - Country:US
Mailing Address - Phone:240-361-9000
Mailing Address - Fax:
Practice Address - Street 1:15204 OMEGA DR STE 310
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4816
Practice Address - Country:US
Practice Address - Phone:240-361-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist