Provider Demographics
NPI:1558541300
Name:OLIVER, WILLIAM G (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 SAN PEDRO DR NE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4120
Mailing Address - Country:US
Mailing Address - Phone:505-979-3574
Mailing Address - Fax:
Practice Address - Street 1:2325 SAN PEDRO DR NE
Practice Address - Street 2:SUITE 1C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4120
Practice Address - Country:US
Practice Address - Phone:505-979-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist