Provider Demographics
NPI:1730290842
Name:OLIVER, JACQUELINE D (PT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:P
Other - Last Name:DIRR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:732-779-0853
Mailing Address - Fax:
Practice Address - Street 1:530 LAKEHURST RD
Practice Address - Street 2:SUITE 202/204
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8063
Practice Address - Country:US
Practice Address - Phone:732-349-1201
Practice Address - Fax:732-349-1202
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00927200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist