Provider Demographics
NPI:1144424052
Name:OLIVER, ELENITA BAUTISTA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELENITA
Middle Name:BAUTISTA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1142
Mailing Address - Country:US
Mailing Address - Phone:718-386-3124
Mailing Address - Fax:
Practice Address - Street 1:1732 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1142
Practice Address - Country:US
Practice Address - Phone:718-386-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist