Provider Demographics
NPI:1366750317
Name:OLIVER, HOLLAN S (DPT)
Entity type:Individual
Prefix:
First Name:HOLLAN
Middle Name:S
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:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:DEER ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04627-0264
Mailing Address - Country:US
Mailing Address - Phone:207-348-3334
Mailing Address - Fax:866-454-2555
Practice Address - Street 1:5 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DEER ISLE
Practice Address - State:ME
Practice Address - Zip Code:04627
Practice Address - Country:US
Practice Address - Phone:207-348-3334
Practice Address - Fax:866-454-2555
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist