Provider Demographics
NPI:1306908074
Name:SAN PEDRO, OLIVER LAWRENCE ZAPANTA (PT)
Entity type:Individual
Prefix:MR
First Name:OLIVER LAWRENCE
Middle Name:ZAPANTA
Last Name:SAN PEDRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:OLIVER LAWRENCE
Other - Middle Name:ZAPANTA
Other - Last Name:SAN PEDRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:211 ZUBER PL
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:167 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-2009
Practice Address - Country:US
Practice Address - Phone:201-641-1600
Practice Address - Fax:201-807-0231
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA01102800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080427Medicare UPIN