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General NPI Number Information
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NPI Number | 1518259332
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Entity Type | Individual
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Provider Name | CHARETTA SHAWNETTE OLIVER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 2121 FOUNTAIN DR SUITE E
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City | SNELLVILLE
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State | GA
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Zip | 30078-7023
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Country | US
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Telephone | 770-736-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 3447 N DRUID HILLS RD L
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City | DECATUR
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State | GA
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Zip | 30033-3764
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Country | US
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Telephone | 301-520-6458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 871175
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT012193
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License Number State | GA
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