Provider Demographics
NPI:1306002316
Name:OLIVER, CHRISTINE GARDNER (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:GARDNER
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 1:12300 APACHE AVE APT 320
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2319
Mailing Address - Country:US
Mailing Address - Phone:912-704-4874
Mailing Address - Fax:
Practice Address - Street 1:11800 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1908
Practice Address - Country:US
Practice Address - Phone:912-925-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist