=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295792810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY CHRISTOPHER OLIVERI P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 02/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1670 EMPIRE BLVD SUITE 400
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14580-2119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-217-2697
-----------------------------------------------------
Fax | 585-671-5242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 831
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14580-0831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-217-2697
-----------------------------------------------------
Fax | 585-671-5242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 008582-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------