Provider Demographics
NPI:1508342791
Name:OLIVER, EPHRAIM (LMT)
Entity Type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7706
Mailing Address - Country:US
Mailing Address - Phone:570-369-2721
Mailing Address - Fax:
Practice Address - Street 1:528 SEVEN BRIDGE RD UNIT 235
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7618
Practice Address - Country:US
Practice Address - Phone:570-369-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist