Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 11109 | TX |
N | 225100000X | Physical Therapist | 1125649 | TX |
NPI | 1386886422 |
---|---|
Provider Name | Charles A Oliver |
First Address | San Antonio, TX 78258-4231 |
Second Address | San Antonio, TX 78258-4231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 06/04/2009 |