Provider Demographics
NPI:1871485094
Name:OLIVEIRA SPORT AND ORTHOPEDIC PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:OLIVEIRA SPORT AND ORTHOPEDIC PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:209-844-5012
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-0337
Mailing Address - Country:US
Mailing Address - Phone:209-844-5012
Mailing Address - Fax:
Practice Address - Street 1:157 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3128
Practice Address - Country:US
Practice Address - Phone:209-844-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty