Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2074800 | TX |
NPI | 1003458712 |
---|---|
Provider Name | Erick D Oliver |
First Address | Grand Prairie, TX 75052-3020 |
Second Address | Grand Prairie, TX 75052-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2019 |
Last Update Date | 14/10/2019 |