Individual
OLLIE MENYETTA TOLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
300 CROWN POINTE BLVD, WEATHERFORD, TX 76087-1160
(817) 757-1224
Mailing address
12609 PANORAMA DR, BURLESON, TX 76028-7075
(601) 672-6678
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2095040
TX
Other
Enumeration date
10/10/2018
Last updated
10/10/2018
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