Provider Demographics
NPI:1477380350
Name:OLIVER, SYDNEY ELAINE (PT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ELAINE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PARK ST APT B
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-3294
Mailing Address - Country:US
Mailing Address - Phone:501-425-1648
Mailing Address - Fax:
Practice Address - Street 1:720 N GASKILL ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-9104
Practice Address - Country:US
Practice Address - Phone:479-621-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist