Provider Demographics
NPI:1205065612
Name:AMARVI, OLUSHOLA (PT)
Entity type:Individual
Prefix:
First Name:OLUSHOLA
Middle Name:
Last Name:AMARVI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 HARNED ST
Mailing Address - Street 2:11B
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-1714
Mailing Address - Country:US
Mailing Address - Phone:908-883-0265
Mailing Address - Fax:732-225-2435
Practice Address - Street 1:826 HARNED ST
Practice Address - Street 2:11B
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-1714
Practice Address - Country:US
Practice Address - Phone:973-278-7115
Practice Address - Fax:973-279-7551
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01230300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist