Provider Demographics
NPI:1124503024
Name:OLIVER, COLBY GENEA' (PTA)
Entity type:Individual
Prefix:MRS
First Name:COLBY
Middle Name:GENEA'
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0438
Mailing Address - Country:US
Mailing Address - Phone:606-464-9688
Mailing Address - Fax:606-464-9687
Practice Address - Street 1:63 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-4131
Practice Address - Country:US
Practice Address - Phone:606-464-9688
Practice Address - Fax:606-464-9687
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03846225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant