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General NPI Number Information
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NPI Number | 1699354720
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Entity Type | Individual
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Provider Name | EBONY OLIVER PTA
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Gender | Female
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 8267 ELMBROOK DR STE 100
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City | DALLAS
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State | TX
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Zip | 75247-4051
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Country | US
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Telephone | 832-320-3193
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Fax |
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Provider Business Mailing Address
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Address Line | 2777 N GARLAND AVE APT 61
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City | GARLAND
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State | TX
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Zip | 75040-1920
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Country | US
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Telephone | 434-579-0184
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2160648
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License Number State | TX
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