Provider Demographics
NPI:1205070133
Name:OLIVER, JANE MARGUERITE (MPT)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARGUERITE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2403
Mailing Address - Country:US
Mailing Address - Phone:843-545-5188
Mailing Address - Fax:843-520-4864
Practice Address - Street 1:219 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2403
Practice Address - Country:US
Practice Address - Phone:843-545-5188
Practice Address - Fax:843-520-4864
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist