MEDICARE: MS. JAZLYN OLIVER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	053415	NY

General Provider Information

NPI Number	:	1346066164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAZLYN OLIVER DPT

Provider Business Mailing Address
First Line	:	92 WEST AVE
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-1376
Country	:	US
Telephone Number	:	585-637-0790
Fax Number	:	585-637-3572

Provider Business Practice Location Address
First Line	:	3240 CHILI AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-5438
Country	:	US
Telephone Number	:	585-451-4660
Fax Number	:	585-889-8282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2024
Last Update Date	:	11/26/2024

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