Provider Demographics
NPI:1093608697
Name:VICENTE OLIVA, MARILIZ (PTA)
Entity type:Individual
Prefix:
First Name:MARILIZ
Middle Name:
Last Name:VICENTE OLIVA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 SW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2164
Mailing Address - Country:US
Mailing Address - Phone:786-371-4437
Mailing Address - Fax:
Practice Address - Street 1:8415 SW 156TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2164
Practice Address - Country:US
Practice Address - Phone:786-371-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34044208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation