Provider Demographics
NPI:1679761084
Name:OLLIS, AMELIA GIBSON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:GIBSON
Last Name:OLLIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1407 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5305
Mailing Address - Country:US
Mailing Address - Phone:843-769-0663
Mailing Address - Fax:843-769-0665
Practice Address - Street 1:1407 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5305
Practice Address - Country:US
Practice Address - Phone:843-769-0663
Practice Address - Fax:843-769-0665
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC4414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist