Provider Demographics
NPI:1881707990
Name:OLIVERAS-LOPEZ, ROSANNE M (RPT)
Entity type:Individual
Prefix:MRS
First Name:ROSANNE
Middle Name:M
Last Name:OLIVERAS-LOPEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 W 68TH ST
Mailing Address - Street 2:# 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4527
Mailing Address - Country:US
Mailing Address - Phone:305-772-3366
Mailing Address - Fax:
Practice Address - Street 1:1480 W 68TH ST
Practice Address - Street 2:#101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4527
Practice Address - Country:US
Practice Address - Phone:305-818-2213
Practice Address - Fax:305-817-8548
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY010AOtherBLUE CROSS BLUE SHIELD
FLE7451AMedicare PIN