Provider Demographics
NPI:1730807629
Name:OLIVEIRA, NICHOLAS KENNETH (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:KENNETH
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 GRANITE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5350
Mailing Address - Country:US
Mailing Address - Phone:781-807-6138
Mailing Address - Fax:
Practice Address - Street 1:73 TURNPIKE RD
Practice Address - Street 2:UNIT 1A BLDG C
Practice Address - City:IPSWITCH
Practice Address - State:MA
Practice Address - Zip Code:01938
Practice Address - Country:US
Practice Address - Phone:978-312-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist