MEDICARE: MR. DAVID ARTHUR OLIPHANT ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	552	TN

General Provider Information

NPI Number	:	1578564035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ARTHUR OLIPHANT ATC

Provider Business Mailing Address
First Line	:	740 BLUEFIELD AVE
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-0314
Country	:	US
Telephone Number	:	209-668-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 S SANTA CRUZ AVE
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95354-4254
Country	:	US
Telephone Number	:	209-341-7152
Fax Number	:	209-341-4731

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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