Provider Demographics
NPI:1740518836
Name:OLIVER, TERESA (LMT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 11TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4017
Mailing Address - Country:US
Mailing Address - Phone:413-374-9376
Mailing Address - Fax:
Practice Address - Street 1:1144 TALLEVAST RD STE 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-6213
Practice Address - Country:US
Practice Address - Phone:941-359-9090
Practice Address - Fax:941-360-1595
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist