Healthcare Provider Details

I. General information

NPI: 1740284603
Provider Name (Legal Business Name): FREDRICK A OLIVER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 LAKE FOREST DR STE 150
CINCINNATI OH
45242-3781
US

IV. Provider business mailing address

4555 LAKE FOREST DR STE 150
CINCINNATI OH
45242-3781
US

V. Phone/Fax

Practice location:
  • Phone: 877-327-2278
  • Fax: 888-322-2278
Mailing address:
  • Phone: 877-327-2278
  • Fax: 888-322-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 09980
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number005788
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: