Provider Demographics
NPI:1295125912
Name:OLIVA, ROMEO JR (PT)
Entity type:Individual
Prefix:MR
First Name:ROMEO
Middle Name:
Last Name:OLIVA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 CHATALET LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-4625
Mailing Address - Country:US
Mailing Address - Phone:719-564-2000
Mailing Address - Fax:719-564-1830
Practice Address - Street 1:2118 CHATALET LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-4625
Practice Address - Country:US
Practice Address - Phone:719-564-2000
Practice Address - Fax:719-564-1830
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist