Provider Demographics
NPI:1346066164
Name:OLIVER, JAZLYN (DPT)
Entity type:Individual
Prefix:MS
First Name:JAZLYN
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1376
Mailing Address - Country:US
Mailing Address - Phone:585-637-0790
Mailing Address - Fax:585-637-3572
Practice Address - Street 1:3240 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5438
Practice Address - Country:US
Practice Address - Phone:585-451-4660
Practice Address - Fax:585-889-8282
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist