Healthcare Provider Details

I. General information

NPI: 1710185301
Provider Name (Legal Business Name): MARK ALLAN OLIVER DPT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 E MAIN ST STE A-1
ABINGDON VA
24210-3488
US

IV. Provider business mailing address

432 E MAIN ST STE A-1
ABINGDON VA
24210-3488
US

V. Phone/Fax

Practice location:
  • Phone: 276-608-4468
  • Fax: 276-240-1010
Mailing address:
  • Phone: 276-608-4468
  • Fax: 276-240-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number002567
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number050102053
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305202418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: