Provider Demographics
NPI:1053548867
Name:MIETH, OLGA (MOMPT)
Entity type:Individual
Prefix:MISS
First Name:OLGA
Middle Name:
Last Name:MIETH
Suffix:
Gender:F
Credentials:MOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3794 CLAIREMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5916
Mailing Address - Country:US
Mailing Address - Phone:858-483-1600
Mailing Address - Fax:858-483-1611
Practice Address - Street 1:3794 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5916
Practice Address - Country:US
Practice Address - Phone:858-483-1600
Practice Address - Fax:858-483-1611
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist