Gwendolyn Marie Oliver, P.T.A

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

TE011305 Issued in PA

Practice address

404 E Harford St
Milford, PA 18337-1028

Phone

(570) 409-9191

NPI assigned

Jul 8, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499472000000",
    "number": "1356863633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 SPRUCE LAKE DR",
            "city": "MILFORD",
            "state": "PA",
            "postal_code": "183374278",
            "telephone_number": "570-369-9133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 E HARFORD ST",
            "city": "MILFORD",
            "state": "PA",
            "postal_code": "183371028",
            "telephone_number": "570-409-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "GWENDOLYN",
        "middle_name": "MARIE",
        "credential": "P.T.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-08",
        "last_updated": "2017-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "PA",
            "license": "TE011305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Practices of Northeastern PA

• Physical Therapy Assistant in Milford, PA
• Providers in Milford, PA by specialty
• Physical Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.