Provider Demographics
NPI:1699259317
Name:OLIVER, NORELL (PT, DPT)
Entity type:Individual
Prefix:
First Name:NORELL
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9765 SOUTHBROOK DR APT 2712
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0410
Mailing Address - Country:US
Mailing Address - Phone:818-939-9289
Mailing Address - Fax:
Practice Address - Street 1:6639 SOUTHPOINT PKWY STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8042
Practice Address - Country:US
Practice Address - Phone:904-296-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist