Provider Demographics
NPI:1316902893
Name:OLIVER, DAVID M (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MONTCLAIR PLACE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:734-913-4551
Mailing Address - Fax:
Practice Address - Street 1:505 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176
Practice Address - Country:US
Practice Address - Phone:734-944-1005
Practice Address - Fax:734-944-1303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7961225100000X
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist