Provider Demographics
NPI:1922181700
Name:OLIVENCIA, OVIDIO (MPT)
Entity Type:Individual
Prefix:
First Name:OVIDIO
Middle Name:
Last Name:OLIVENCIA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 JEFFERSON AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3483
Mailing Address - Country:US
Mailing Address - Phone:954-610-0066
Mailing Address - Fax:
Practice Address - Street 1:8622 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4567
Practice Address - Country:US
Practice Address - Phone:954-472-7526
Practice Address - Fax:954-472-5605
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI361ZMedicare PIN