Provider Demographics
NPI:1386422574
Name:OLIVER, WILLIAM JACKSON IV (PTA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACKSON
Last Name:OLIVER
Suffix:IV
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4469 VERANDA LAKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-9243
Mailing Address - Country:US
Mailing Address - Phone:336-662-3737
Mailing Address - Fax:336-663-0249
Practice Address - Street 1:4469 VERANDA LAKE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-9243
Practice Address - Country:US
Practice Address - Phone:336-662-3737
Practice Address - Fax:336-663-0249
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6734225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant