Provider Demographics
NPI:1942302849
Name:OLIVER, TONI (DPT)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HIGUERA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6135
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:350 POSADA LN STE 103
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4061
Practice Address - Country:US
Practice Address - Phone:805-434-2050
Practice Address - Fax:805-434-0065
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU092ZMedicare PIN
CABU092YMedicare PIN
AZZ125709Medicare PIN
CAWPT21429AMedicare PIN
CAOPT214290Medicare PIN