Most Relevant Information
Provider Data
| NPI Number: | 1003655812 |
| Provider Name: | OLIVIA IBACH PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | PTA-010895 |
Most Important Dates
| Enumeration Date: | 05/21/2024 |
| Last Updated: | 06/30/2024 |
Provider Practice Location
22507 N 31ST AVE UNIT 13
PHOENIX
AZ
850271693
Practice Location Phone/Fax
| Phone: | 6026700713 |
| Fax: |
Provider Mailing Location
22507 N 31ST AVE UNIT 13
PHOENIX
AZ
850271693
Provider Mailing Phone/Fax
| Phone: | 6026700713 |
| Fax: |