Provider Demographics
NPI:1952064545
Name:OLIVER, RYAN M (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5832
Mailing Address - Country:US
Mailing Address - Phone:315-765-0063
Mailing Address - Fax:315-765-0201
Practice Address - Street 1:2504 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5832
Practice Address - Country:US
Practice Address - Phone:315-765-0063
Practice Address - Fax:315-765-0201
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047742-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty