Provider Demographics
NPI:1740284603
Name:OLIVER, FREDRICK A (PT)
Entity type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:A
Last Name:OLIVER
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 1:4555 LAKE FOREST DR
Mailing Address - Street 2:STE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3781
Mailing Address - Country:US
Mailing Address - Phone:877-327-2278
Mailing Address - Fax:888-322-2278
Practice Address - Street 1:4555 LAKE FOREST DR
Practice Address - Street 2:STE 150
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3781
Practice Address - Country:US
Practice Address - Phone:877-327-2278
Practice Address - Fax:888-322-2278
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 099802251X0800X
KY0057882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630442Medicaid
OH4136003Medicare PIN