Provider Demographics
NPI:1003384934
Name:OLIVER, THEODORE RONALD (DPT)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:RONALD
Last Name:OLIVER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5561
Mailing Address - Country:US
Mailing Address - Phone:951-660-2340
Mailing Address - Fax:
Practice Address - Street 1:17050 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-2806
Practice Address - Country:US
Practice Address - Phone:833-399-1402
Practice Address - Fax:951-848-9676
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2952962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic