Provider Demographics
NPI:1659727170
Name:OLIVO, MARC JOSEPH (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOSEPH
Last Name:OLIVO
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 FANNIN ST
Mailing Address - Street 2:APARTMENT 1311
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-7647
Mailing Address - Country:US
Mailing Address - Phone:484-767-9606
Mailing Address - Fax:
Practice Address - Street 1:4400 ALDINE MAIL RTE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-5913
Practice Address - Country:US
Practice Address - Phone:484-767-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer