Provider Demographics
NPI:1750456620
Name:OLIVER, LISA ARDELIA (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ARDELIA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16334 MORNING MIST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-4728
Mailing Address - Country:US
Mailing Address - Phone:281-440-1842
Mailing Address - Fax:
Practice Address - Street 1:16334 MORNING MIST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4728
Practice Address - Country:US
Practice Address - Phone:281-440-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT10272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer