Provider Demographics
NPI:1710326863
Name:OLIVER PHYSICAL THERAPY AND SPORTS MEDICINE CENTERS INC
Entity Type:Organization
Organization Name:OLIVER PHYSICAL THERAPY AND SPORTS MEDICINE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-815-1302
Mailing Address - Street 1:6110 SYLLING DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6128
Mailing Address - Country:US
Mailing Address - Phone:361-815-1302
Mailing Address - Fax:
Practice Address - Street 1:1028 S 14TH ST
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-6422
Practice Address - Country:US
Practice Address - Phone:361-815-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy