Provider Demographics
NPI:1003275116
Name:URISTA, ADRIANA (MT)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:URISTA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-0210
Mailing Address - Country:US
Mailing Address - Phone:513-480-4491
Mailing Address - Fax:513-480-4493
Practice Address - Street 1:215 E FOREST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45065-1311
Practice Address - Country:US
Practice Address - Phone:513-480-4491
Practice Address - Fax:513-480-4493
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000OtherNONE