Basic Information
| Provider Information | |||||||||
| NPI: | 1730807629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVEIRA | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | KENNETH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 GRANITE ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021845350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818076138 | ||||||||
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| Practice Location | |||||||||
| Address1: | 73 TURNPIKE RD | ||||||||
| Address2: | UNIT 1A BLDG C | ||||||||
| City: | IPSWITCH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783122804 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 26361 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.