Provider Demographics
NPI:1922790310
Name:FILICETTI, OLIVIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:FILICETTI
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 1:5418 N EAGLE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0999
Mailing Address - Country:US
Mailing Address - Phone:208-501-8264
Mailing Address - Fax:
Practice Address - Street 1:1175 E PARKCENTER BLVD STE 104A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6752
Practice Address - Country:US
Practice Address - Phone:208-807-2486
Practice Address - Fax:208-806-9698
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist