Provider Demographics
NPI:1053010298
Name:OLYMPIA INNOVATIONS LLC
Entity type:Organization
Organization Name:OLYMPIA INNOVATIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHART
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:484-951-7268
Mailing Address - Street 1:21 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2271
Mailing Address - Country:US
Mailing Address - Phone:484-515-1023
Mailing Address - Fax:
Practice Address - Street 1:69 TOWNE DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4201
Practice Address - Country:US
Practice Address - Phone:484-515-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy