MEDICARE: SUSANNE KAY OLIVER P.T.

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	1228	AR

General Provider Information

NPI Number	:	1841479615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNE KAY OLIVER P.T.

Provider Business Mailing Address
First Line	:	2317 E YVONNE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4246
Country	:	US
Telephone Number	:	479-263-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	2317 E YVONNE DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4246
Country	:	US
Telephone Number	:	479-263-2447
Fax Number	:

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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