Individual
CHARLES CODY OLIVER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
7211 W FRANKLIN RD, BOISE, ID 83709-0926
(208) 375-4200
Mailing address
3161 S GLACIER BAY WAY, MERIDIAN, ID 83642-7824
(208) 871-3235
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT-3307
ID
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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