Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT295296 | CA |
NPI | 1003384934 |
---|---|
Provider Name | Theodore Ronald Oliver |
First Address | Redlands, CA 92374-5561 |
Second Address | Riverside, CA 92518-2806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2018 |
Last Update Date | 18/06/2021 |