Olivia Paige Mock, PTA
Individual provider Active NPI Physical Therapy Assistant · Pennville, IN
NPI 1750101242 · NPPES record last updated Oct 10, 2024
Key facts
- NPI
- 1750101242
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 013616 (OH)
- Practice address
- PO Box 222
Pennville, IN 47369-0222 - Phone
- (937) 489-9710
- NPI assigned
- Oct 10, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013616 | OH | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 013616 | OH | Yes |
Addresses
Primary practice location
PO Box 222
Pennville, IN 47369-0222
Mailing address
PO Box 222
Pennville, IN 47369-0222
Phone (937) 489-9710
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.