MEDICARE: OLIVER OCO PT

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	2251X0800X	Orthopedic Physical Therapist	25623	CA

General Provider Information

NPI Number	:	1558982850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER OCO PT

Provider Business Mailing Address
First Line	:	5478 ALEXANDRINE CT
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92057-1908
Country	:	US
Telephone Number	:	760-805-7708
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 EL CAMINO REAL
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1603
Country	:	US
Telephone Number	:	760-476-2900
Fax Number	:

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

Provider Enumeration Date	:	04/28/2020
Last Update Date	:	04/28/2020

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Directions to “ OLIVER OCO PT” Practice Location

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