Provider Demographics
NPI:1629253851
Name:OLIVO, JEFFREY MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:OLIVO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 923387
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-3387
Mailing Address - Country:US
Mailing Address - Phone:678-584-1622
Mailing Address - Fax:678-584-1673
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:STE 120
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:678-584-1622
Practice Address - Fax:678-584-1673
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0054862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic