Provider Demographics
NPI:1578123006
Name:OLIVERIO, DOMINIC THOMAS (ATC)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:THOMAS
Last Name:OLIVERIO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 PARK AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-7406
Mailing Address - Country:US
Mailing Address - Phone:859-319-5001
Mailing Address - Fax:
Practice Address - Street 1:1825 AIRPORT EXCHANGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3900
Practice Address - Country:US
Practice Address - Phone:859-647-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTCA7562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer